Healthcare Provider Details

I. General information

NPI: 1235069899
Provider Name (Legal Business Name): MAUREEN OLAITAN DOSUNMU-KAGHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 MCLEANSVILLE RD UNIT 23
MC LEANSVILLE NC
27301-0108
US

IV. Provider business mailing address

5711 MCLEANSVILLE RD UNIT 23
MC LEANSVILLE NC
27301-0108
US

V. Phone/Fax

Practice location:
  • Phone: 336-501-5754
  • Fax:
Mailing address:
  • Phone: 336-501-5754
  • Fax: 336-501-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number314183
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: