Provider Demographics
NPI:1053934141
Name:AJIBOYE, OLUWAKEMI AYOBAMI (NP)
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:AYOBAMI
Last Name:AJIBOYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10095 WARD RD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2731
Mailing Address - Country:US
Mailing Address - Phone:410-257-0191
Mailing Address - Fax:
Practice Address - Street 1:10095 WARD RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2731
Practice Address - Country:US
Practice Address - Phone:410-257-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995524363LF0000X
MD003666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily