Provider Demographics
NPI:1831748664
Name:ADEYEMI, FOLAKE A (CRNP)
Entity type:Individual
Prefix:
First Name:FOLAKE
Middle Name:A
Last Name:ADEYEMI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 GORDON CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5830
Mailing Address - Country:US
Mailing Address - Phone:410-746-5704
Mailing Address - Fax:
Practice Address - Street 1:9308 GORDON CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5830
Practice Address - Country:US
Practice Address - Phone:410-746-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033165207QA0505X
MDR209844207QA0505X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN1033165OtherLICENSE NUMBER
MDR209844OtherLICENSE NUMBER