Healthcare Provider Details

I. General information

NPI: 1174089239
Provider Name (Legal Business Name): ADEBOLA A ADEJUWON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 THOMAS JOHNSON DR
FREDERICK MD
21702-4386
US

IV. Provider business mailing address

178 THOMAS JOHNSON DR STE 204L
FREDERICK MD
21702-4352
US

V. Phone/Fax

Practice location:
  • Phone: 301-673-1901
  • Fax:
Mailing address:
  • Phone: 301-673-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR220058
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1033944
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: