Healthcare Provider Details

I. General information

NPI: 1740825413
Provider Name (Legal Business Name): OLAYINKA O TOBY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLAYINKA O MOSES CRNP PMHNP

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WINDBLUFF CT
OWINGS MILLS MD
21117-2471
US

IV. Provider business mailing address

40 WINDBLUFF CT
OWINGS MILLS MD
21117-2471
US

V. Phone/Fax

Practice location:
  • Phone: 410-497-4237
  • Fax:
Mailing address:
  • Phone: 410-497-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR177381
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR177381
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR177381
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR177381
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: