Provider Demographics
NPI:1902360118
Name:AJOGUN, ANDREA (CRNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:AJOGUN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 BRENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4902
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:410-496-6448
Practice Address - Street 1:3510 BRENBROOK DR
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4902
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:410-496-6448
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily