Healthcare Provider Details

I. General information

NPI: 1790320372
Provider Name (Legal Business Name): AFOLAKE A. ADEWUMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E LAKE ST # MC626
MINNEAPOLIS MN
55407-4385
US

IV. Provider business mailing address

2215 E LAKE ST # MC626
MINNEAPOLIS MN
55407-4385
US

V. Phone/Fax

Practice location:
  • Phone: 612-596-9438
  • Fax:
Mailing address:
  • Phone: 612-596-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR-232337-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7058
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: