Provider Demographics
NPI:1336838028
Name:GBADEHAN, FLORENCE OLUWAFUNMILOLA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:OLUWAFUNMILOLA
Last Name:GBADEHAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:O
Other - Last Name:AJIBULU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 ENERGY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5272
Mailing Address - Country:US
Mailing Address - Phone:651-252-6070
Mailing Address - Fax:651-252-6071
Practice Address - Street 1:1600 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3898
Practice Address - Country:US
Practice Address - Phone:651-379-5157
Practice Address - Fax:651-379-5159
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10191163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health