Healthcare Provider Details

I. General information

NPI: 1295666477
Provider Name (Legal Business Name): MOBOLANLE HENRIETTA OSINUBI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 OLD SCAGGSVILLE RD
LAUREL MD
20723-1726
US

IV. Provider business mailing address

9070 OLD SCAGGSVILLE RD
LAUREL MD
20723-1726
US

V. Phone/Fax

Practice location:
  • Phone: 240-264-0634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201435
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: