Healthcare Provider Details

I. General information

NPI: 1992668826
Provider Name (Legal Business Name): OLAJUMOKE OGUNBAYO APRN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CLARENDON WAY
MANCHESTER NH
03103-2818
US

IV. Provider business mailing address

13 CLARENDON WAY
MANCHESTER NH
03103-2818
US

V. Phone/Fax

Practice location:
  • Phone: 603-264-5440
  • Fax:
Mailing address:
  • Phone: 603-264-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number087223-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number087223-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: