Provider Demographics
NPI:1922822659
Name:ADENIPEKUN, ADETUNJI
Entity type:Individual
Prefix:
First Name:ADETUNJI
Middle Name:
Last Name:ADENIPEKUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BENJAMIN AVE
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-4301
Mailing Address - Country:US
Mailing Address - Phone:312-834-9016
Mailing Address - Fax:
Practice Address - Street 1:101 BENJAMIN AVE
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-4301
Practice Address - Country:US
Practice Address - Phone:312-834-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health