MEDICARE: BOLAJOKO OLUFUNKE ASONIBARE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	940357	TX

General Provider Information

NPI Number	:	1366934804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOLAJOKO OLUFUNKE ASONIBARE RN

Provider Business Mailing Address
First Line	:	10409 MONTGOMERY PKWY NE STE 202B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3852
Country	:	US
Telephone Number	:	505-910-4070
Fax Number	:	505-910-4587

Provider Business Practice Location Address
First Line	:	10409 MONTGOMERY PKWY NE STE 202B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3852
Country	:	US
Telephone Number	:	505-910-4070
Fax Number	:	505-910-4587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	03/10/2026

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