Healthcare Provider Details

I. General information

NPI: 1427103399
Provider Name (Legal Business Name): ADELEKE ADONIS OYEMADE CRNA, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/18/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673RD MEDICAL GROUP 5955 ZEAMER AVE
JBER AK
99506
US

IV. Provider business mailing address

673RD MDG 5955 ZEAMER AVE
JBER AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-3104
  • Fax:
Mailing address:
  • Phone: 907-580-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number676455
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221109
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number3619
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number680124
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-302400
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100018-C
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number676455
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3619
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number221109
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: