Provider Demographics
NPI:1770454068
Name:DADA, ADEBOLA PETER (RN)
Entity type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:PETER
Last Name:DADA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 QUINTANA ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6627
Mailing Address - Country:US
Mailing Address - Phone:763-447-7518
Mailing Address - Fax:218-316-7387
Practice Address - Street 1:14441 QUINTANA ST NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6627
Practice Address - Country:US
Practice Address - Phone:763-447-7518
Practice Address - Fax:218-316-7387
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2519135163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty