Individual
MUTIAT AJIBADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1401 S. 31 STREET, PHIALDELPHIA, PA 19146
(215) 925-2400
Mailing address
131 MAGPIE LN, COATESVILLE, PA 19320-4355
(484) 250-1032
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP021594
PA
Other
Enumeration date
03/02/2020
Last updated
09/11/2023
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