=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922674944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AYOKUNLE O OJO NURSE PRACTITIONER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2021
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 RIDGE RD
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21237-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-350-1131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 N POINT BLVD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-624-5125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R199402
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------