Healthcare Provider Details

I. General information

NPI: 1013602606
Provider Name (Legal Business Name): OBIAGELI OGBODO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 LAUREL BOWIE RD STE 209
BOWIE MD
20715-1712
US

IV. Provider business mailing address

8402 HILLVIEW RD
LANDOVER MD
20785-4841
US

V. Phone/Fax

Practice location:
  • Phone: 240-206-8345
  • Fax:
Mailing address:
  • Phone: 240-264-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR142257
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: