MUTIAT AJIBADE


Address: 1401 S. 31 Street, Phialdelphia, PA 19146
Phone: 2159252400

MUTIAT AJIBADE (NPI# 1407480155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1407480155
Entity Type Individual
Full Name MUTIAT AJIBADE
Credential NURSE PRACTITIONER
Practice Address 1401 S. 31 Street
Phialdelphia
PA 19146
Mailing Address 131 Magpie Ln
Coatesville
PA 19320-4355
Practice Telephone 2159252400
Mailing Telephone 4842501032
Enumeration Date 2020-03-02
Last Update Date 2020-03-02
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
SP021594 PA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 1401 S. 31 STREET
City PHIALDELPHIA
State PA
Zip Code 19146

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1942638101 Woong Yi Pharmacist 1155 S.mole St, Philadelphia, PA 19146 2013-10-28
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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Competitor

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City PHIALDELPHIA
Zip Code 19146

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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