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General NPI Number Information
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NPI Number | 1225211295
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Entity Type | Individual
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Provider Name | TEMITOPE O AJIBADE CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1 CLARA MAASS DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3550
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Country | US
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Telephone | 718-208-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 WALT WHITMAN RD STE 300
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City | MELVILLE
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State | NY
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Zip | 11747-4300
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Country | US
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Telephone | 516-370-3861
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN583759
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 536691
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License Number State | NY
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