Provider Demographics
NPI:1194890319
Name:OLADUNJOYE, BUSURAT KIKELOMO (NP)
Entity type:Individual
Prefix:MRS
First Name:BUSURAT
Middle Name:KIKELOMO
Last Name:OLADUNJOYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BUSURAT
Other - Middle Name:KIKELOMO
Other - Last Name:OLADUNJOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3907 EDITH DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-8104
Mailing Address - Country:US
Mailing Address - Phone:229-435-1294
Mailing Address - Fax:478-744-9552
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:952-936-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN126090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1194890319Medicaid