Provider Demographics
NPI:1801343843
Name:ASHAGBE, ASISAT OMOTAYO (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:ASISAT
Middle Name:OMOTAYO
Last Name:ASHAGBE
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WEIR DR STE 270
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-6741
Mailing Address - Country:US
Mailing Address - Phone:240-593-5653
Mailing Address - Fax:
Practice Address - Street 1:2042 WOODDALE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2981
Practice Address - Country:US
Practice Address - Phone:612-662-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202065363LF0000X
MNCNP4931363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily