Healthcare Provider Details

I. General information

NPI: 1033340278
Provider Name (Legal Business Name): MODUPE TOGUN DNP, FNP-BC, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 N ROLLING RD
WINDSOR MILL MD
21244-2023
US

IV. Provider business mailing address

3110 N ROLLING RD
WINDSOR MILL MD
21244-2023
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-1931
  • Fax: 410-298-1932
Mailing address:
  • Phone: 410-298-1931
  • Fax: 410-298-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR167650
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR167650
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: