Healthcare Provider Details

I. General information

NPI: 1891559746
Provider Name (Legal Business Name): DORIS OGUNMAKINWA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL PARK DR STE D
WALDORF MD
20602-2729
US

IV. Provider business mailing address

2925 WINTERBOURNE DR
UPPER MARLBORO MD
20774-9103
US

V. Phone/Fax

Practice location:
  • Phone: 667-382-8624
  • Fax: 667-218-3708
Mailing address:
  • Phone: 202-744-2347
  • Fax: 667-218-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR160384
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: