Provider Demographics
NPI:1629720685
Name:AJANAKU, ABBI (DNP)
Entity Type:Individual
Prefix:
First Name:ABBI
Middle Name:
Last Name:AJANAKU
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:OLATOKUNBO
Other - Middle Name:
Other - Last Name:AJANAKU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1404 S MAIN CHAPEL WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1860
Mailing Address - Country:US
Mailing Address - Phone:443-642-1211
Mailing Address - Fax:
Practice Address - Street 1:1660 NORTHBOURNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3623
Practice Address - Country:US
Practice Address - Phone:443-642-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185040163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Single Specialty