MEDICARE: ADEJOKE ADEDEJI APRN PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3626	MN

General Provider Information

NPI Number	:	1164813366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEJOKE ADEDEJI APRN PMHNP-BC

Provider Business Mailing Address
First Line	:	14031 BURNHAVEN DR STE 106
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4474
Country	:	US
Telephone Number	:	952-955-4110
Fax Number	:	952-955-7482

Provider Business Practice Location Address
First Line	:	14031 BURNHAVEN DR STE 106
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4474
Country	:	US
Telephone Number	:	952-955-4110
Fax Number	:	952-955-7482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	03/12/2025

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