Healthcare Provider Details

I. General information

NPI: 1487379251
Provider Name (Legal Business Name): FAITH OLABISI AREGBESOLA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 25TH ST # 101
BALTIMORE MD
21218-5359
US

IV. Provider business mailing address

40 BLUE HERON CT
MIDDLE RIVER MD
21220-7518
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7174
  • Fax:
Mailing address:
  • Phone: 443-739-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR234018
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR234018
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: