Provider Demographics
NPI:1952771289
Name:AJAVON, ABLAWA
Entity Type:Individual
Prefix:
First Name:ABLAWA
Middle Name:
Last Name:AJAVON
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 1:3406 NEWTON ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-2126
Mailing Address - Country:US
Mailing Address - Phone:240-505-8928
Mailing Address - Fax:
Practice Address - Street 1:3521 OTIS ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-2158
Practice Address - Country:US
Practice Address - Phone:240-505-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide