Provider Demographics
NPI:1124880976
Name:OLOGUNTERE, ADEDOJA ADEBISI
Entity type:Individual
Prefix:
First Name:ADEDOJA
Middle Name:ADEBISI
Last Name:OLOGUNTERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GUILD RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1461
Mailing Address - Country:US
Mailing Address - Phone:774-441-2694
Mailing Address - Fax:
Practice Address - Street 1:4 GUILD RD UNIT 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1461
Practice Address - Country:US
Practice Address - Phone:774-441-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2354701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse