Healthcare Provider Details

I. General information

NPI: 1932073145
Provider Name (Legal Business Name): OLUWAKEMI VICTORIA FATOKIMI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 WATERLOO RD
JESSUP MD
20794-9783
US

IV. Provider business mailing address

100 WASHINGTON AVE S STE 900
MINNEAPOLIS MN
55401-2455
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR248478
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: