Provider Demographics
NPI:1528527017
Name:AJAYI, OLUWASEYI JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:OLUWASEYI
Middle Name:JENNIFER
Last Name:AJAYI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 BEALE LOOP
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3473
Mailing Address - Country:US
Mailing Address - Phone:256-617-0813
Mailing Address - Fax:
Practice Address - Street 1:1904 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3517
Practice Address - Country:US
Practice Address - Phone:256-617-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166474163W00000X
NC5014202363LP0808X
WAAP61397829363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse