Healthcare Provider Details

I. General information

NPI: 1699009472
Provider Name (Legal Business Name): ODUNOLA FOLUKE GBENRO-AJIBADE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST
COLUMBUS OH
43213-2086
US

IV. Provider business mailing address

5628 PAYTON WAY
COLUMBUS OH
43235-7241
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3345
  • Fax:
Mailing address:
  • Phone: 614-271-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 15245 - NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: