Provider Demographics
NPI:1881262509
Name:JONGBO, OLAJUMOKE OMOLOLA (PMHNP)
Entity type:Individual
Prefix:
First Name:OLAJUMOKE
Middle Name:OMOLOLA
Last Name:JONGBO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43713 W COWPATH RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5662
Mailing Address - Country:US
Mailing Address - Phone:602-865-9753
Mailing Address - Fax:702-608-7752
Practice Address - Street 1:43713 W COWPATH RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5662
Practice Address - Country:US
Practice Address - Phone:602-865-9753
Practice Address - Fax:702-608-7752
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN204392163W00000X
AZ291899363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse