Provider Demographics
NPI:1487414876
Name:ADEWUNMI, ADEKANBI CHIJIOKE
Entity type:Individual
Prefix:MR
First Name:ADEKANBI
Middle Name:CHIJIOKE
Last Name:ADEWUNMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MINE LAKE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6417
Mailing Address - Country:US
Mailing Address - Phone:919-847-3309
Mailing Address - Fax:919-518-8295
Practice Address - Street 1:140 MINE LAKE CT STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:919-847-3309
Practice Address - Fax:919-518-8295
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00004492793172A00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver