NPIMap

Individual provider Active NPI

Adenike Oyebisi Obisesan

  • Family Nurse Practitioner
  • Golden Valley, MN
National Provider Identifier
1477310977
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11229 Issued in MN
Practice address
820 Lilac Dr N Ste 140
Golden Valley, MN 55422-4791
Phone
(763) 465-0500
NPI assigned
Mar 1, 2024
Last updated
Mar 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11229 MN Primary
Nurse Practitioner 363L00000X 11229 MN

Addresses

Primary practice location

820 Lilac Dr N Ste 140
Golden Valley, MN 55422-4791

Mailing address

820 Lilac Dr N Ste 140
Golden Valley, MN 55422-4791
Phone (763) 465-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250423001063 MN Practitioner - Nurse Practitioner 2567987498 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeris Medical Group PLLCGroup PAC ID 0042624306, 26 clinicians
Twin Cities Physicians Professional CorporationGroup PAC ID 9830499763, 66 clinicians

Practice addresses (Care Compare)

St Louis Park, MN 55416
Phone (914) 589-5503

1415 Lilac Dr N
Suite 190
Golden Valley, MN 55422-4544
Phone (763) 267-8701

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11229MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Medical Plus Nurse Practitioner CurrentSince Jan 18, 2025 Accepting new patients
Twin Cities Physicians Professional Corporation Nurse Practitioner CurrentSince Jun 26, 2025 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

121 Washington Ave N
Fl 4
Minneapolis, MN 55401
Phone (404) 992-2702

1415 Lilac Dr N
Ste 190
Minneapolis, MN 55422
Phone (763) 267-8701

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1477310977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LILAC DR N STE 140",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224791",
            "telephone_number": "763-465-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LILAC DR N STE 140",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224791",
            "telephone_number": "763-465-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBISESAN",
        "first_name": "ADENIKE",
        "middle_name": "OYEBISI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-01",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "11229",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "11229",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

Verify at the official NPI Registry.