Provider Demographics
NPI:1801660915
Name:AJAYI, ABIDEMI ANIKE (APRN-RNP, PMHNP)
Entity type:Individual
Prefix:
First Name:ABIDEMI
Middle Name:ANIKE
Last Name:AJAYI
Suffix:
Gender:F
Credentials:APRN-RNP, PMHNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANIKE
Other - Last Name:AJAYI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3107 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-9093
Mailing Address - Country:US
Mailing Address - Phone:480-432-4237
Mailing Address - Fax:
Practice Address - Street 1:2500 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6037
Practice Address - Country:US
Practice Address - Phone:480-432-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ300023363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health