Basic Information
| Provider Information | |||||||||
| NPI: | 1184878399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADETUNJI | ||||||||
| FirstName: | OLUYEMISI | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 ROUTE 73 N STE C | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565128108 | ||||||||
| FaxNumber: | 8562675824 | ||||||||
| Practice Location | |||||||||
| Address1: | 851 ROUTE 73 N STE C | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565128108 | ||||||||
| FaxNumber: | 8562675824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2008 | ||||||||
| LastUpdateDate: | 02/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR13341900 | NJ | Y | Nursing Service Providers | Registered Nurse | 363LP0808X | 26NJ00697500 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.