Provider Demographics
NPI:1538742374
Name:ADENIRAN, ANTHONY A (RN, DNP)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:ADENIRAN
Suffix:
Gender:M
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BURMONT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4504
Mailing Address - Country:US
Mailing Address - Phone:610-513-7590
Mailing Address - Fax:
Practice Address - Street 1:1230 BURMONT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4504
Practice Address - Country:US
Practice Address - Phone:610-513-7590
Practice Address - Fax:610-449-1175
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN534427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101540673Medicaid