Provider Demographics
NPI:1255121646
Name:AJIBO, TOCHUKWU IFEOMA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:TOCHUKWU
Middle Name:IFEOMA
Last Name:AJIBO
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21701 76TH AVE W STE 301
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7500
Mailing Address - Country:US
Mailing Address - Phone:425-230-4858
Mailing Address - Fax:
Practice Address - Street 1:21701 76TH AVE W STE 301
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7500
Practice Address - Country:US
Practice Address - Phone:425-230-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX980564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health