Provider Demographics
NPI:1225730310
Name:FOSU, OPANIN BA (CRNP)
Entity Type:Individual
Prefix:
First Name:OPANIN BA
Middle Name:
Last Name:FOSU
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6994 MERLE CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6943
Mailing Address - Country:US
Mailing Address - Phone:240-643-2662
Mailing Address - Fax:
Practice Address - Street 1:6994 MERLE CT
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6943
Practice Address - Country:US
Practice Address - Phone:240-643-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223350363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health