Healthcare Provider Details

I. General information

NPI: 1922650787
Provider Name (Legal Business Name): OLUWABUNMI D. ADEBAYO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W AVON RD
ROCHESTER HILLS MI
48307-2704
US

IV. Provider business mailing address

50 N PERRY ST
PONTIAC MI
48342-2217
US

V. Phone/Fax

Practice location:
  • Phone: 248-218-2000
  • Fax:
Mailing address:
  • Phone: 248-218-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704297840
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number000012459474
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2018078420
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05190099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: