Provider Demographics
NPI:1982092409
Name:AJIFOWOKE, AKANNI
Entity Type:Individual
Prefix:
First Name:AKANNI
Middle Name:
Last Name:AJIFOWOKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 MATTHEWS CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2008
Mailing Address - Country:US
Mailing Address - Phone:301-943-8638
Mailing Address - Fax:
Practice Address - Street 1:8937 MATTHEWS CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2008
Practice Address - Country:US
Practice Address - Phone:301-943-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse