Provider Demographics
NPI:1902599871
Name:AJAGBE, DAVID BABALOLA (RN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BABALOLA
Last Name:AJAGBE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 EYRIE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4303
Mailing Address - Country:US
Mailing Address - Phone:651-428-5704
Mailing Address - Fax:
Practice Address - Street 1:2425 EYRIE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-4303
Practice Address - Country:US
Practice Address - Phone:651-428-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR167930-4163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health