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General NPI Number Information
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NPI Number | 1013775014
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Entity Type | Organization
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Legal Business Name | VIVIAN IMO PSYCHIATRY, LLC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1412 CRAIN HWY N STE 6B
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City | GLEN BURNIE
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State | MD
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Zip | 21061-9306
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Country | US
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Telephone | 301-337-6669
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Fax | 301-477-8931
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Provider Business Mailing Address
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Address Line | 1412 CRAIN HWY N STE 6B
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City | GLEN BURNIE
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State | MD
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Zip | 21061-9306
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Country | US
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Telephone | 301-377-6669
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Fax | 301-477-8931
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIVIAN ADAEZE IMO
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Credential | DNP, CRNP-PMH
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Telephone | 301-821-7488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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