=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255753489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FOLAKE ALOBA CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2014
-----------------------------------------------------
Last Update Date | 09/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3415 HAMILTON ST STE 6
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20782-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-363-0707
-----------------------------------------------------
Fax | 240-714-4733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2607 BOX TREE DR
-----------------------------------------------------
City | UPPER MARLBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20774-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 120-236-1592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | R189544
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------