Healthcare Provider Details

I. General information

NPI: 1265847149
Provider Name (Legal Business Name): OLALEKAN PATRICK OBADIYA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 UNIVERSITY AVE SE
MINNEAPOLIS MN
55414-3325
US

IV. Provider business mailing address

1210 COUNTY ROAD J STE 102
SAINT PAUL MN
55127-6826
US

V. Phone/Fax

Practice location:
  • Phone: 612-454-2260
  • Fax:
Mailing address:
  • Phone: 651-235-7704
  • Fax: 612-454-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR153974-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: