Healthcare Provider Details

I. General information

NPI: 1194206821
Provider Name (Legal Business Name): ADEREMI A JUNAID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 EDINBURGH DR
ANNA TX
75409-0287
US

IV. Provider business mailing address

733 EDINBURGH DR
ANNA TX
75409-0287
US

V. Phone/Fax

Practice location:
  • Phone: 214-451-8727
  • Fax:
Mailing address:
  • Phone: 214-451-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number311362
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: