MEDICARE: MODUPEOLA CHRISTIANAH AKINJOLIRE MSN, PMHNP-BC

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	71016923A	IN
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	2025020180	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609660364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MODUPEOLA CHRISTIANAH AKINJOLIRE MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	8754 LAURELTON PL
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5809
Country	:	US
Telephone Number	:	301-765-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	8754 LAURELTON PL
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5809
Country	:	US
Telephone Number	:	301-765-4539
Fax Number	:

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

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	06/08/2026

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