Healthcare Provider Details

I. General information

NPI: 1386567311
Provider Name (Legal Business Name): MUFUTIAT OYEGUNLE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DEFENSE HWY STE 307
CROFTON MD
21114-2930
US

IV. Provider business mailing address

2200 DEFENSE HWY STE 307
CROFTON MD
21114-2930
US

V. Phone/Fax

Practice location:
  • Phone: 301-327-0328
  • Fax:
Mailing address:
  • Phone: 301-327-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR222661
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: