Healthcare Provider Details

I. General information

NPI: 1598101958
Provider Name (Legal Business Name): LATONYA M ADESUNLOYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12289 HANCOCK ST SUITE 34
CARMEL IN
46032-5801
US

IV. Provider business mailing address

12289 HANCOCK ST SUITE 34
CARMEL IN
46032-5801
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-8950
  • Fax: 317-815-8951
Mailing address:
  • Phone: 317-815-8950
  • Fax: 317-815-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28206222A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: