Healthcare Provider Details

I. General information

NPI: 1942827258
Provider Name (Legal Business Name): GRACE OLUWATOYIN EFUNBAJO DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SARVIS AVE STE 302
RIVERDALE MD
20737-1394
US

IV. Provider business mailing address

5711 SARVIS AVE STE 302
RIVERDALE MD
20737-1394
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-7800
  • Fax:
Mailing address:
  • Phone: 301-927-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR200931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: