Healthcare Provider Details

I. General information

NPI: 1336838028
Provider Name (Legal Business Name): FLORENCE OLUWAFUNMILOLA GBADEHAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FLORENCE O AJIBULU

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 UNIVERSITY AVE W
SAINT PAUL MN
55104-3898
US

IV. Provider business mailing address

1400 ENERGY PARK DR
SAINT PAUL MN
55108-5272
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-5157
  • Fax: 651-379-5159
Mailing address:
  • Phone: 651-252-6070
  • Fax: 651-252-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number10191
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10191
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: