Healthcare Provider Details

I. General information

NPI: 1891559761
Provider Name (Legal Business Name): OLUWASEYI AJAYI DNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9134 SHERWOOD CT
SAINT JOHN IN
46373-0619
US

IV. Provider business mailing address

9134 SHERWOOD CT
SAINT JOHN IN
46373-0619
US

V. Phone/Fax

Practice location:
  • Phone: 219-413-6641
  • Fax:
Mailing address:
  • Phone: 219-413-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28276137A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041.410514
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.028983
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015183A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: