Provider Demographics
NPI:1790657633
Name:OFAKUNRIN, OLUBODUN AJIBAYO (PMHNP, CNP)
Entity type:Individual
Prefix:
First Name:OLUBODUN
Middle Name:AJIBAYO
Last Name:OFAKUNRIN
Suffix:
Gender:M
Credentials:PMHNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6557 WILDFLOWER DR S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-1729
Mailing Address - Country:US
Mailing Address - Phone:651-815-3158
Mailing Address - Fax:
Practice Address - Street 1:6557 WILDFLOWER DR S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-1729
Practice Address - Country:US
Practice Address - Phone:651-815-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health