Healthcare Provider Details

I. General information

NPI: 1174070858
Provider Name (Legal Business Name): CATHERINE ONOGIMENAJE OGUNSOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ONOGIMENAJE EHIEMUA CRNP

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13238 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2640
US

IV. Provider business mailing address

PO BOX 157
ASHTON MD
20861-0157
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-3814
  • Fax:
Mailing address:
  • Phone: 301-570-9700
  • Fax: 301-260-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR205050
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: