Healthcare Provider Details

I. General information

NPI: 1073436960
Provider Name (Legal Business Name): RUTH MARIE ADEKUNLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 W ROUND PRAIRIE AVE
WILLISTON ND
58801-9024
US

IV. Provider business mailing address

5014 W ROUND PRAIRIE AVE
WILLISTON ND
58801-9024
US

V. Phone/Fax

Practice location:
  • Phone: 218-689-1276
  • Fax:
Mailing address:
  • Phone: 218-689-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberND859513
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: