Provider Demographics
NPI:1124418728
Name:DADA, TOLULOPE (APRN)
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:DADA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47815 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9572
Practice Address - Country:US
Practice Address - Phone:541-782-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178688363LP0808X
AZAP9915363LP0808X
FLAPRN9356454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500823827Medicaid
FL014272200Medicaid