Healthcare Provider Details

I. General information

NPI: 1518713668
Provider Name (Legal Business Name): ADESOLA ADEFOWOJU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PLEASANT RIDGE DR STE G
OWINGS MILLS MD
21117-2560
US

IV. Provider business mailing address

1130 DARGON QUARRY LN
BRUNSWICK MD
21716-9731
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-6893
  • Fax: 443-869-4437
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210660
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: