Provider Demographics
NPI:1982170213
Name:AJANI, TAIWO OLUGBENGA (DNP, CRNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:TAIWO
Middle Name:OLUGBENGA
Last Name:AJANI
Suffix:
Gender:F
Credentials:DNP, CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E NORTHERN PKWY STE T7
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2120
Mailing Address - Country:US
Mailing Address - Phone:443-713-8643
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 120
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3180
Practice Address - Country:US
Practice Address - Phone:443-713-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1002193363LA2200X
MDR159659363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health