Healthcare Provider Details

I. General information

NPI: 1629720685
Provider Name (Legal Business Name): ABBI AJANAKU DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLATOKUNBO AJANAKU

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 NORTHBOURNE RD
BALTIMORE MD
21239-3623
US

IV. Provider business mailing address

1404 S MAIN CHAPEL WAY STE 104
GAMBRILLS MD
21054-1860
US

V. Phone/Fax

Practice location:
  • Phone: 443-642-1211
  • Fax:
Mailing address:
  • Phone: 443-642-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberR185040
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: