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General NPI Number Information
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NPI Number | 1043882533
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Entity Type | Individual
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Provider Name | BOSE AJAYI
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Gender | Female
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 800 MAINE AVE SW
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City | WASHINGTON
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State | DC
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Zip | 20024-2805
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Country | US
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Telephone | 202-730-5436
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Fax |
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Provider Business Mailing Address
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Address Line | 8280 WILLOW OAKS CORPORATE DR STE 600
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City | FAIRFAX
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State | VA
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Zip | 22031-4516
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Country | US
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Telephone | 202-730-5436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NONE
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP1024705
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License Number State | DC
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