Healthcare Provider Details

I. General information

NPI: 1801312053
Provider Name (Legal Business Name): ADEDIWURA AJADI JOLAOSO AGNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E BALTIMORE ST UNIT 1-R
BALTIMORE MD
21202-4706
US

IV. Provider business mailing address

3904 DEEP HOLLOW WAY
BOWIE MD
20721-1287
US

V. Phone/Fax

Practice location:
  • Phone: 240-245-4164
  • Fax:
Mailing address:
  • Phone: 240-245-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR193343
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR193343
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP1028737
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR193343
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1028737
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: