Healthcare Provider Details

I. General information

NPI: 1871180968
Provider Name (Legal Business Name): OMOTUNDE ADEYEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 HUNTERS MEADOW LN
RALEIGH NC
27606-8488
US

IV. Provider business mailing address

2529 HUNTERS MEADOW LN
RALEIGH NC
27606-8488
US

V. Phone/Fax

Practice location:
  • Phone: 513-658-0761
  • Fax:
Mailing address:
  • Phone: 513-658-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF08200047
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014281
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014281
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: