Healthcare Provider Details

I. General information

NPI: 1316411390
Provider Name (Legal Business Name): ADETOUN ADESIDA ABOLURIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8852 S JACKJAY DR UNIT 502
OAK CREEK WI
53154-5871
US

IV. Provider business mailing address

4315 FALCON MEADOW DR
KATY TX
77449-4048
US

V. Phone/Fax

Practice location:
  • Phone: 832-428-3692
  • Fax:
Mailing address:
  • Phone: 832-428-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: