Healthcare Provider Details

I. General information

NPI: 1184498362
Provider Name (Legal Business Name): ADETINUKE OLUWATOYIN OKUSANYA CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 CHESTNUT AVE
BOWIE MD
20715-4527
US

IV. Provider business mailing address

8403 CHESTNUT AVE
BOWIE MD
20715-4527
US

V. Phone/Fax

Practice location:
  • Phone: 240-280-6918
  • Fax:
Mailing address:
  • Phone: 240-280-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR226406
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: