Healthcare Provider Details

I. General information

NPI: 1518602168
Provider Name (Legal Business Name): MUJIDAT OBARO CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10343 STEWARDS CHANCE LN
WHITE PLAINS MD
20695-3297
US

IV. Provider business mailing address

10343 STEWARDS CHANCE LN
WHITE PLAINS MD
20695-3297
US

V. Phone/Fax

Practice location:
  • Phone: 202-277-9429
  • Fax:
Mailing address:
  • Phone: 202-277-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR170901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: