Healthcare Provider Details

I. General information

NPI: 1962385575
Provider Name (Legal Business Name): OPEYEMI TAIWO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14848 SILVER ASH CT
BURTONSVILLE MD
20866-1337
US

IV. Provider business mailing address

14848 SILVER ASH CT
BURTONSVILLE MD
20866-1337
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-8685
  • Fax:
Mailing address:
  • Phone: 240-547-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR231124
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR231124
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: