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NPI Code Detail

MEDICARE: MRS. RUTH DAMILOLA ADEPETUN PMHNP-BC

MEDICARE: MRS. RUTH DAMILOLA ADEPETUN PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP60931406WA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5009234NC

General Provider Information

NPI Number : 1518362862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RUTH DAMILOLA ADEPETUN PMHNP-BC
Provider Business Mailing Address
First Line : 311 WILLIAMSON RD STE 103
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-5967
Country : US
Telephone Number : 704-360-3049
Fax Number : 704-973-9588
Provider Business Practice Location Address
First Line : 311 WILLIAMSON RD STE 103
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-5967
Country : US
Telephone Number : 704-360-3049
Fax Number : 704-973-9588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2014
Last Update Date : 03/17/2020

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