Healthcare Provider Details

I. General information

NPI: 1831024769
Provider Name (Legal Business Name): OLUWADEMILADE ELIZABETH FAJEMISIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S HENDERSON ST
SEATTLE WA
98108-4720
US

IV. Provider business mailing address

5328 CRITTENDEN ST
HYATTSVILLE MD
20781-2633
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-5277
  • Fax:
Mailing address:
  • Phone: 240-815-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR249901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: