Healthcare Provider Details

I. General information

NPI: 1518695691
Provider Name (Legal Business Name): OLUBANKE OLATUNDUN ADESANYA DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BANKE ADESANYA DNP, APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 05/09/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 SOCIAVILLE FOSTER ROAD, SUITE C
MASON OH
45040
US

IV. Provider business mailing address

4738 SADDLETOP RIDGE LN
MASON OH
45040-3850
US

V. Phone/Fax

Practice location:
  • Phone: 513-204-1910
  • Fax:
Mailing address:
  • Phone: 513-432-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0035334
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number464340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: