Provider Demographics
NPI:1447808613
Name:AJOMAGBERIN, OLAYINKA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:OLAYINKA
Middle Name:
Last Name:AJOMAGBERIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 E EAGER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1229
Mailing Address - Country:US
Mailing Address - Phone:212-729-6854
Mailing Address - Fax:
Practice Address - Street 1:5010 YORK RD STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4486
Practice Address - Country:US
Practice Address - Phone:410-433-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily