Provider Demographics
NPI:1912708439
Name:IPADEOLA, MUIDEEN A (APN)
Entity type:Individual
Prefix:
First Name:MUIDEEN
Middle Name:A
Last Name:IPADEOLA
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 TAMARIND PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3886
Mailing Address - Country:US
Mailing Address - Phone:862-452-8988
Mailing Address - Fax:862-452-8988
Practice Address - Street 1:1152 TAMARIND PL
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3886
Practice Address - Country:US
Practice Address - Phone:862-452-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15298300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health