Provider Demographics
NPI:1821829953
Name:ADEBOGUN, REMILEKUN M (RN)
Entity type:Individual
Prefix:MRS
First Name:REMILEKUN
Middle Name:M
Last Name:ADEBOGUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12051 N BRIARHILL RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2601
Mailing Address - Country:US
Mailing Address - Phone:414-803-0792
Mailing Address - Fax:262-661-7743
Practice Address - Street 1:W72N675 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1725
Practice Address - Country:US
Practice Address - Phone:414-803-0792
Practice Address - Fax:262-661-7743
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0019576310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility