MEDICARE: DR. OMOLARA ADEGUN DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP016532	PA

General Provider Information

NPI Number	:	1467901900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMOLARA ADEGUN DNP

Provider Business Mailing Address
First Line	:	505 WINDSOR RD
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-1878
Country	:	US
Telephone Number	:	267-872-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-310-7022
Fax Number	:	267-281-1744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	05/17/2026

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