Healthcare Provider Details

I. General information

NPI: 1477329217
Provider Name (Legal Business Name): YETUNDE ADEYERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

209 KIRBYS LANDING CT
ODENTON MD
21113-2625
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5386
  • Fax:
Mailing address:
  • Phone: 773-837-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR195848
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR195848
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: