Provider Demographics
NPI:1205102332
Name:AJAYI, OLUBUKOLA (RN)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:AJAYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BACON ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5542
Mailing Address - Country:US
Mailing Address - Phone:401-722-3560
Mailing Address - Fax:401-722-8522
Practice Address - Street 1:101 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-722-3560
Practice Address - Fax:401-722-8522
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN50459374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid