Healthcare Provider Details

I. General information

NPI: 1063246866
Provider Name (Legal Business Name): YEWANDE MORONKE OBASA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 ENDERS LN
BOWIE MD
20716-7330
US

IV. Provider business mailing address

3810 ENDERS LN
BOWIE MD
20716-7330
US

V. Phone/Fax

Practice location:
  • Phone: 301-254-9273
  • Fax:
Mailing address:
  • Phone: 301-254-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN212343
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: