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General NPI Number Information
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NPI Number | 1417833856
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Entity Type | Organization
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Legal Business Name | REJUVARIS
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 9635 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-2436
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Country | US
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Telephone | 410-929-4790
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Fax |
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Provider Business Mailing Address
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Address Line | 9635 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-2436
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Country | US
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Telephone | 410-929-4790
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. ABISOLA ALADE
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Credential | DNP,CRNP
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Telephone | 410-929-4790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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