Healthcare Provider Details

I. General information

NPI: 1093495251
Provider Name (Legal Business Name): BILIKIS OGUNNIYI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

IV. Provider business mailing address

661 LAKEMONT DR
GLEN BURNIE MD
21060-8793
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-8632
  • Fax:
Mailing address:
  • Phone: 410-979-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR225900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: