Healthcare Provider Details

I. General information

NPI: 1275242448
Provider Name (Legal Business Name): MAUREEN OWOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 05/01/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 TAYLOR AVE STE 104
TOWSON MD
21286-8315
US

IV. Provider business mailing address

9606 MAXWELL RD
MIDDLE RIVER MD
21220-3792
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-0180
  • Fax:
Mailing address:
  • Phone: 443-823-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208285
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR208285
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: