MEDICARE: MS. OLUYEMISI OLAYINKA ADEDOTUN APRN

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	364SF0001X	Family Health Clinical Nurse Specialist	26NJ00276700	NJ
2	364SH0200X	Home Health Clinical Nurse Specialist	26NJ00276700	NJ
3	363L00000X	Nurse Practitioner	APN001368	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN001368	OTHER	NV	NV LICENSE

General Provider Information

NPI Number	:	1629393632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLUYEMISI OLAYINKA ADEDOTUN APRN

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5018
Country	:	US
Telephone Number	:	702-444-4690
Fax Number	:	702-444-0977

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5018
Country	:	US
Telephone Number	:	702-444-4690
Fax Number	:	702-444-0977

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

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	03/15/2021

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