Provider Demographics
NPI:1124675111
Name:ADUMATIOGE, ATINUKE TAIBAT (RN)
Entity type:Individual
Prefix:
First Name:ATINUKE
Middle Name:TAIBAT
Last Name:ADUMATIOGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 VALLEY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8842
Mailing Address - Country:US
Mailing Address - Phone:214-518-2332
Mailing Address - Fax:
Practice Address - Street 1:1067 VALLEY BROOK LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8842
Practice Address - Country:US
Practice Address - Phone:214-518-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX816189163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse