MEDICARE: OLUYEMISI ADETUNJI APN

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	26NR13341900	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00697500	NJ

General Provider Information

NPI Number	:	1184878399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUYEMISI ADETUNJI APN

Provider Business Mailing Address
First Line	:	851 ROUTE 73 N STE C
Second Line	:	SUITE C
City	:	MARLTON
State	:	NJ
Zip	:	08053-1275
Country	:	US
Telephone Number	:	856-512-8108
Fax Number	:	856-267-5824

Provider Business Practice Location Address
First Line	:	851 ROUTE 73 N STE C
Second Line	:	SUITE C
City	:	MARLTON
State	:	NJ
Zip	:	08053-1275
Country	:	US
Telephone Number	:	856-512-8108
Fax Number	:	856-267-5824

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

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	02/15/2017

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