Healthcare Provider Details

I. General information

NPI: 1962284471
Provider Name (Legal Business Name): OLUFISAYO OMOBO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

516 N ROLLING RD STE 305
BALTIMORE MD
21228-4142
US

V. Phone/Fax

Practice location:
  • Phone: 443-498-1313
  • Fax:
Mailing address:
  • Phone: 443-498-1313
  • Fax: 443-590-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR245800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: