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General NPI Number Information
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NPI Number | 1801343843
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Entity Type | Individual
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Provider Name | ASISAT OMOTAYO ASHAGBE FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 2042 WOODDALE DR
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City | WOODBURY
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State | MN
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Zip | 55125-2981
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Country | US
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Telephone | 612-662-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 WEIR DR STE 270
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City | WOODBURY
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State | MN
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Zip | 55125-6741
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Country | US
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Telephone | 240-593-5653
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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 | R202065
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License Number State | MD
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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 | CNP4931
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP4931
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License Number State | MN
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