Healthcare Provider Details

I. General information

NPI: 1740669209
Provider Name (Legal Business Name): GLADYS AJOHMBU ESUNJI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 48TH ST NE
WASHINGTON DC
20019-3607
US

IV. Provider business mailing address

721 48TH ST NE
WASHINGTON DC
20019-3607
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-9844
  • Fax: 202-541-9845
Mailing address:
  • Phone: 202-541-9844
  • Fax: 202-541-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210396
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1033347
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1033347
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: