Provider Demographics
NPI:1043882533
Name:AJAYI, BOSE ROSE
Entity Type:Individual
Prefix:
First Name:BOSE
Middle Name:ROSE
Last Name:AJAYI
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 1:490 TAYLOR ST NE APT 13J
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1549
Mailing Address - Country:US
Mailing Address - Phone:202-730-5436
Mailing Address - Fax:
Practice Address - Street 1:490 TAYLOR ST NE APT 13J
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1549
Practice Address - Country:US
Practice Address - Phone:202-730-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNONE363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health