Healthcare Provider Details

I. General information

NPI: 1477811800
Provider Name (Legal Business Name): CALISTA OGBU DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 SAINT BARNABAS RD STE G
TEMPLE HILLS MD
20748-1842
US

IV. Provider business mailing address

4302 SAINT BARNABAS RD STE G
TEMPLE HILLS MD
20748-1842
US

V. Phone/Fax

Practice location:
  • Phone: 240-200-6838
  • Fax: 800-853-3149
Mailing address:
  • Phone: 240-200-6838
  • Fax: 800-853-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR207370
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1031030
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR207370
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: