Healthcare Provider Details

I. General information

NPI: 1528789179
Provider Name (Legal Business Name): ADENIYI AKINTUNDE DAWODU DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

20265 ROYAL VILLAGIO CT UNIT 107
ESTERO FL
33928-3168
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone: 612-226-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101768
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: