Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R174545 | MD |
NPI | 1003497215 |
---|---|
Provider Name | Adedayo Temitope Omobo |
First Address | Bowie, MD 20720-3368 |
Second Address | Owings Mills, MD 21117-3249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2021 |
Last Update Date | 19/04/2021 |