Healthcare Provider Details

I. General information

NPI: 1679922298
Provider Name (Legal Business Name): ADETIMBO ADEDIRAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9435 PARAGON CT
OWINGS MILLS MD
21117-1408
US

IV. Provider business mailing address

9435 PARAGON CT
OWINGS MILLS MD
21117-1408
US

V. Phone/Fax

Practice location:
  • Phone: 240-722-9763
  • Fax:
Mailing address:
  • Phone: 240-722-9763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR194824
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR194854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: