Provider Demographics
NPI:1174941868
Name:AJAYI, NANCY PHILLIPPA (LPN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:PHILLIPPA
Last Name:AJAYI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GENUNG ST
Mailing Address - Street 2:APARTMENT 1010
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2557
Mailing Address - Country:US
Mailing Address - Phone:845-321-6584
Mailing Address - Fax:
Practice Address - Street 1:203 GENUNG ST
Practice Address - Street 2:APARTMENT 1010
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2557
Practice Address - Country:US
Practice Address - Phone:845-321-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse