Provider Demographics
NPI:1033340278
Name:TOGUN, MODUPE (DNP, FNP-BC, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:MODUPE
Middle Name:
Last Name:TOGUN
Suffix:
Gender:F
Credentials:DNP, FNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2023
Mailing Address - Country:US
Mailing Address - Phone:410-298-1931
Mailing Address - Fax:410-298-1932
Practice Address - Street 1:3110 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2023
Practice Address - Country:US
Practice Address - Phone:410-298-1931
Practice Address - Fax:410-298-1932
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167650363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033777300Medicaid