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General NPI Number Information
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NPI Number | 1245609775
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Entity Type | Individual
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Provider Name | ESTHER OPEMIPO SHADARE DNP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1401 MADISON PARK DR STE 201
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5881
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Country | US
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Telephone | 410-787-5704
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Fax | 410-787-5714
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Provider Business Mailing Address
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Address Line | 1401 MADISON PARK DR STE 201
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5881
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Country | US
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Telephone | 410-787-5704
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Fax | 410-787-5714
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN1030978
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R206030
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024185798
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R206030
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License Number State | MD
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