Provider Demographics
NPI:1356180319
Name:AJEWOLE, ABIMBOLA PRECIOUS
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:PRECIOUS
Last Name:AJEWOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 IMPATIENS CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1664
Mailing Address - Country:US
Mailing Address - Phone:763-354-0351
Mailing Address - Fax:
Practice Address - Street 1:4629 IMPATIENS CT N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1664
Practice Address - Country:US
Practice Address - Phone:763-354-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2494600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse