MEDICARE: FAVOUR OFOEGBU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN1021770	DC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R183067	MD

General Provider Information

NPI Number	:	1891036604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAVOUR OFOEGBU

Provider Business Mailing Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	410-230-1830
Fax Number	:	410-230-1830

Provider Business Practice Location Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	410-230-1830
Fax Number	:	410-230-1830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	04/30/2025

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Directions to “ FAVOUR OFOEGBU ” Practice Location

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