Healthcare Provider Details

I. General information

NPI: 1912678244
Provider Name (Legal Business Name): BABATUNDE OLUJOBI CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11405 VILLA CT
UPPER MARLBORO MD
20774-5702
US

IV. Provider business mailing address

11405 VILLA CT
UPPER MARLBORO MD
20774-5702
US

V. Phone/Fax

Practice location:
  • Phone: 240-321-9637
  • Fax: 833-666-0851
Mailing address:
  • Phone: 240-321-9637
  • Fax: 833-666-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR202077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: