Provider Demographics
NPI:1073170205
Name:OLAJUYIGBE, OLAYEMI EBENEZER (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:OLAYEMI
Middle Name:EBENEZER
Last Name:OLAJUYIGBE
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 PATUXENT OAK CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6172
Mailing Address - Country:US
Mailing Address - Phone:443-538-6352
Mailing Address - Fax:
Practice Address - Street 1:7720 PATUXENT OAK CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6172
Practice Address - Country:US
Practice Address - Phone:443-538-6352
Practice Address - Fax:443-820-3026
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health