Healthcare Provider Details

I. General information

NPI: 1679087605
Provider Name (Legal Business Name): OLUWAFEMI A ADISA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER ST STE T100
ANCHORAGE AK
99508-4674
US

IV. Provider business mailing address

3841 PIPER ST STE T100
ANCHORAGE AK
99508-4674
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-3211
  • Fax: 907-561-4652
Mailing address:
  • Phone: 907-561-3211
  • Fax: 907-561-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number252458
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number188881
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: