Healthcare Provider Details

I. General information

NPI: 1790576270
Provider Name (Legal Business Name): EBUNOLUWA EFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 BELAIR RD
BALTIMORE MD
21206-5146
US

IV. Provider business mailing address

2414 WELLBRIDGE DR APT A
BALTIMORE MD
21234-7324
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-9209
  • Fax:
Mailing address:
  • Phone: 443-722-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR254550
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: