Healthcare Provider Details

I. General information

NPI: 1033868153
Provider Name (Legal Business Name): OPEMIPO DOYIN OGEYINGBO CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 NORVELLE CT
GLEN BURNIE MD
21061-6121
US

IV. Provider business mailing address

464 NORVELLE CT
GLEN BURNIE MD
21061-6121
US

V. Phone/Fax

Practice location:
  • Phone: 301-592-7286
  • Fax:
Mailing address:
  • Phone: 301-592-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR207236
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: