Provider Demographics
NPI:1073004297
Name:O'DARE, RACHEL ADEBUKOLA (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ADEBUKOLA
Last Name:O'DARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADEBUKOLA
Other - Middle Name:RACHEL
Other - Last Name:ORISADARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:43644 ARBORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3347
Mailing Address - Country:US
Mailing Address - Phone:708-299-2318
Mailing Address - Fax:
Practice Address - Street 1:LANDMARK MEDICAL OF MICHIGAN, PC
Practice Address - Street 2:26677 W 12 MILE RD, STE 166
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1514
Practice Address - Country:US
Practice Address - Phone:734-294-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317648163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse