Healthcare Provider Details

I. General information

NPI: 1396681508
Provider Name (Legal Business Name): ELEANOR B OGUNWOMOJU NP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 CASTLESTONE DR
ROSEDALE MD
21237-4907
US

IV. Provider business mailing address

5310 CASTLESTONE DR
ROSEDALE MD
21237-4907
US

V. Phone/Fax

Practice location:
  • Phone: 646-724-4415
  • Fax:
Mailing address:
  • Phone: 646-724-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR222940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: