Healthcare Provider Details

I. General information

NPI: 1871133074
Provider Name (Legal Business Name): DEBORAH ADEKANMI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 PARKDALE PL
INDIANAPOLIS IN
46254-5612
US

IV. Provider business mailing address

5108 WOODHURST LN
INDIANAPOLIS IN
46239-1762
US

V. Phone/Fax

Practice location:
  • Phone: 317-698-9871
  • Fax:
Mailing address:
  • Phone: 317-698-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71012398A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: