Healthcare Provider Details

I. General information

NPI: 1932723178
Provider Name (Legal Business Name): ADENIKE GBADEBO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 6TH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-9043
  • Fax:
Mailing address:
  • Phone: 330-363-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: