Healthcare Provider Details

I. General information

NPI: 1467799361
Provider Name (Legal Business Name): GLORIA ADETOKUNBO OJO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 09/29/2026
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 CRAIN HWY N STE 3A
GLEN BURNIE MD
21061-7000
US

IV. Provider business mailing address

1412 CRAIN HWY N STE 3A
GLEN BURNIE MD
21061-7000
US

V. Phone/Fax

Practice location:
  • Phone: 410-595-5029
  • Fax: 800-611-7439
Mailing address:
  • Phone: 410-595-5029
  • Fax: 800-611-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR145246
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR145246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: