Healthcare Provider Details

I. General information

NPI: 1043838949
Provider Name (Legal Business Name): OLUWAKEMI OGUNSEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W FRANKLIN ST STE 1
BALTIMORE MD
21201-1823
US

IV. Provider business mailing address

9611 MASON LN
LAUREL MD
20723-1907
US

V. Phone/Fax

Practice location:
  • Phone: 410-801-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR177028
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: