Healthcare Provider Details

I. General information

NPI: 1497339386
Provider Name (Legal Business Name): EFEMWONYI F JESUOROBO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 OXON HILL RD STE 290
OXON HILL MD
20745-3141
US

IV. Provider business mailing address

6196 OXON HILL RD STE 290
OXON HILL MD
20745-3141
US

V. Phone/Fax

Practice location:
  • Phone: 240-493-7847
  • Fax: 240-493-7327
Mailing address:
  • Phone: 240-493-7847
  • Fax: 240-493-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EFEMWONYI F JESUOROBO
Title or Position: OWNER OF ENTITY
Credential: DNP, FNP-BC, PMHNP-B
Phone: 202-368-6707