Healthcare Provider Details

I. General information

NPI: 1366934804
Provider Name (Legal Business Name): BOLAJOKO OLUFUNKE ASONIBARE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE STE 202B
ALBUQUERQUE NM
87111-3852
US

IV. Provider business mailing address

10409 MONTGOMERY PKWY NE STE 202B
ALBUQUERQUE NM
87111-3852
US

V. Phone/Fax

Practice location:
  • Phone: 505-910-4070
  • Fax: 505-910-4587
Mailing address:
  • Phone: 505-910-4070
  • Fax: 505-910-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number87285
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: