Healthcare Provider Details

I. General information

NPI: 1689982803
Provider Name (Legal Business Name): ADESHOLA A AFOLABI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13861 OLIO RD
FISHERS IN
46037-3487
US

IV. Provider business mailing address

250 W 96TH ST # 520
INDIANAPOLIS IN
46260-1316
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28204676A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number578768-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004455A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: