Healthcare Provider Details

I. General information

NPI: 1205722188
Provider Name (Legal Business Name): ADENIKE S OGUNBANWO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 88TH CRES N
BROOKLYN PARK MN
55443-3983
US

IV. Provider business mailing address

5501 88TH CRES N
BROOKLYN PARK MN
55443-3983
US

V. Phone/Fax

Practice location:
  • Phone: 763-568-6204
  • Fax: 612-444-7501
Mailing address:
  • Phone: 763-568-6204
  • Fax: 612-444-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2285292
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: