Provider Demographics
NPI:1730880824
Name:AKINBOBOLA, ADEJUMOKE A
Entity type:Individual
Prefix:MRS
First Name:ADEJUMOKE
Middle Name:A
Last Name:AKINBOBOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 VALERIAN LN
Mailing Address - Street 2:
Mailing Address - City:UPPR MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9217
Mailing Address - Country:US
Mailing Address - Phone:240-300-2967
Mailing Address - Fax:
Practice Address - Street 1:3009 VALERIAN LN
Practice Address - Street 2:
Practice Address - City:UPPR MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-9217
Practice Address - Country:US
Practice Address - Phone:240-300-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226537363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health