MEDICARE: DR. ADEOLA GABRIEL OBAYANJU DNP, APN, AGPNP-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	163W00000X	Registered Nurse	26NR12639700	NJ
2	363LG0600X	Gerontology Nurse Practitioner	26NJ01268100	NJ

General Provider Information

NPI Number	:	1164974762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEOLA GABRIEL OBAYANJU DNP, APN, AGPNP-BC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST FL 15
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	800-427-1902
Fax Number	:

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

Provider Enumeration Date	:	10/30/2016
Last Update Date	:	04/29/2022

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