Healthcare Provider Details

I. General information

NPI: 1730989526
Provider Name (Legal Business Name): JEANNE BALENG OKUWOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANNE BALENG OKUWOBI PMHNP-BC

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GUILFORD DR STE 2012
FREDERICK MD
21704-5257
US

IV. Provider business mailing address

1209A N EAST ST
FREDERICK MD
21701-4624
US

V. Phone/Fax

Practice location:
  • Phone: 240-788-3536
  • Fax: 240-788-3922
Mailing address:
  • Phone: 240-788-3536
  • Fax: 240-788-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR237543
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: