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General NPI Number Information
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NPI Number | 1174089239
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Entity Type | Individual
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Provider Name | ADEBOLA A ADEJUWON NP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 1600 CRAIN HWY S STE 301
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City | GLEN BURNIE
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State | MD
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Zip | 21061-6446
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Country | US
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Telephone | 140-787-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 11350 MCCORMICK ROAD EXECUTIVE PLAZA 1 SUITE 501
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City | HUNT VALLEY
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State | MD
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Zip | 21031-6446
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Country | US
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Telephone | 410-329-1070
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1033944
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R220058
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License Number State | MD
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