Healthcare Provider Details

I. General information

NPI: 1912664475
Provider Name (Legal Business Name): MARIAH OWOLABI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 QUIET RIDGE CT
PASADENA MD
21122-7512
US

IV. Provider business mailing address

203 QUIET RIDGE CT
PASADENA MD
21122-7512
US

V. Phone/Fax

Practice location:
  • Phone: 443-366-1848
  • Fax:
Mailing address:
  • Phone: 443-366-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR223419
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10210802
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: