Provider Demographics
NPI:1942588967
Name:GBADEBO, OLATOKUNBO (NP)
Entity type:Individual
Prefix:
First Name:OLATOKUNBO
Middle Name:
Last Name:GBADEBO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E PEMBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4004
Mailing Address - Country:US
Mailing Address - Phone:302-981-3755
Mailing Address - Fax:
Practice Address - Street 1:665 S CARTER RD UNIT 2
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-7728
Practice Address - Country:US
Practice Address - Phone:302-467-2646
Practice Address - Fax:302-467-2857
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000454207Q00000X, 2083X0100X
DELG 0000454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine