MEDICARE: OLUYEMISI D AJIBOLA

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	164W00000X	Licensed Practical Nurse	LPN500020722	DC

General Provider Information

NPI Number	:	1497612741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUYEMISI D AJIBOLA

Provider Business Mailing Address
First Line	:	3993 WARNER AVE APT C6
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2053
Country	:	US
Telephone Number	:	240-825-6422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3993 WARNER AVE APT C6
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2053
Country	:	US
Telephone Number	:	240-825-6422
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ OLUYEMISI D AJIBOLA ” Practice Location

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