Aminat Funmilayo Adedayo, NURSE PRACTITIONER
Individual provider Active NPI Nurse Practitioner · Saint Paul, MN
NPI 1639717333 · NPPES record last updated Sep 25, 2020
Key facts
- NPI
- 1639717333
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 6979 (MN)
- Practice address
- 671 Vandalia St
Saint Paul, MN 55114-1312 - Phone
- (651) 696-5521
- Fax
- (651) 696-5544
- NPI assigned
- Dec 13, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200911001879 | MN | Practitioner - Nurse Practitioner | 4183042872 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6979 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Medical Plus | Nurse Practitioner | Current |
Accepting new patients |
| Community Care Health Network LLC | Nurse Practitioner | Current |
Accepting new patients |
| Planned Parenthood Minnesota, North Dakota, South Dakota | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
15322 Galaxie Ave
Ste 105
Apple Valley, MN 55124
Phone (952) 890-0940
91 Viking Dr W
Little Canada, MN 55117
Phone (651) 489-1328
100 S 5th St
Fl 19
Minneapolis, MN 55402
Phone (612) 482-1050
7532 Brooklyn Blvd
Minneapolis, MN 55443
Phone (763) 560-1555
1200 Lagoon Ave
Minneapolis, MN 55408
Phone (612) 823-6300
121 Washington Ave N
Fl 4
Minneapolis, MN 55401
Phone (404) 992-2702
6527 Lyndale Ave S
Richfield, MN 55423
Phone (612) 874-1420
671 Vandalia St
Saint Paul, MN 55114
Phone (651) 696-5674
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 6979 | MN | Yes |
Addresses
Primary practice location
671 Vandalia St
Saint Paul, MN 55114-1312
Mailing address
1247 Terrace Ave
Maplewood, MN 55109-5511
Phone (651) 235-4042
Other practice location 1
1247 Terrace Ave
Maplewood, MN 55109-5511
Phone (651) 235-4042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6979 | Other | MN | MN LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | MAPLEWOOD | Direct |
Other providers in Saint Paul, MN
- Adapthealth Minnesota LLC
- Sarah Hayes Addicks
- Kami K Addison
- Faduma Abdullahi Addow
- Adewale Adebiyi
- Margaret Adedeji
- Kolawole Isaiah Adediran
- Folake Adelakun
- Tanya Kelly Adelman
- Brett Michael Adelsman
All providers in Saint Paul, MN · Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.