Provider Demographics
NPI:1235917709
Name:AJOSE, OLUWASEUN GBOLABO
Entity Type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:GBOLABO
Last Name:AJOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15966 LOWDERMILK PL
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2752
Mailing Address - Country:US
Mailing Address - Phone:443-938-0460
Mailing Address - Fax:
Practice Address - Street 1:15966 LOWDERMILK PL
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2752
Practice Address - Country:US
Practice Address - Phone:443-938-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003170374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide