Healthcare Provider Details

I. General information

NPI: 1083457774
Provider Name (Legal Business Name): DORIS OFODILE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 BENNING RD NE STE 300A
WASHINGTON DC
20002-4572
US

IV. Provider business mailing address

1647 BENNING RD NE STE 300A
WASHINGTON DC
20002-4572
US

V. Phone/Fax

Practice location:
  • Phone: 240-707-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR243706
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR243706
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR243706
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR243706
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1059356
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: