Healthcare Provider Details

I. General information

NPI: 1164363313
Provider Name (Legal Business Name): TRUVIT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 SANTIAGO RD STE 108
COLUMBIA MD
21045-3958
US

IV. Provider business mailing address

9650 SANTIAGO RD STE 108
COLUMBIA MD
21045-3958
US

V. Phone/Fax

Practice location:
  • Phone: 410-720-2745
  • Fax: 240-935-9581
Mailing address:
  • Phone: 410-720-2745
  • Fax: 240-935-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLANIRETI ONABANJO
Title or Position: CEO
Credential: DNP
Phone: 240-732-1009