Provider Demographics
NPI:1336704584
Name:OGUNNUPE, LABAKE G (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:LABAKE
Middle Name:G
Last Name:OGUNNUPE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 RIVERSIDE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5369
Mailing Address - Country:US
Mailing Address - Phone:202-276-9353
Mailing Address - Fax:
Practice Address - Street 1:547 RIVERSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5369
Practice Address - Country:US
Practice Address - Phone:443-355-7517
Practice Address - Fax:443-733-6050
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health