Healthcare Provider Details

I. General information

NPI: 1851165054
Provider Name (Legal Business Name): ADAEZE JAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 EAGLERIDGE BLVD STE 140
PUEBLO CO
81008-2354
US

IV. Provider business mailing address

892 DUNLIN FIELDS DR
LAWRENCEVILLE GA
30044-7812
US

V. Phone/Fax

Practice location:
  • Phone: 719-679-5022
  • Fax: 719-888-1673
Mailing address:
  • Phone: 404-863-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000862-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN284878
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: