Provider Demographics
NPI:1255689717
Name:ALLIBALOGUN, LINDA HASSAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HASSAN
Last Name:ALLIBALOGUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:F
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, PMHNP
Mailing Address - Street 1:8890 MCDONOGH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5397
Mailing Address - Country:US
Mailing Address - Phone:301-512-0912
Mailing Address - Fax:
Practice Address - Street 1:8890 MCDONOGH RD STE 301
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5397
Practice Address - Country:US
Practice Address - Phone:301-512-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175115363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily