Provider Demographics
NPI:1497428882
Name:HIS &HER MEDICAL AND MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:HIS &HER MEDICAL AND MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:EFEMWONYI
Authorized Official - Middle Name:F
Authorized Official - Last Name:JESUOROBO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, FNP,PMHNP
Authorized Official - Phone:240-493-7847
Mailing Address - Street 1:6196 OXON HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3141
Mailing Address - Country:US
Mailing Address - Phone:240-493-7847
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 290
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3141
Practice Address - Country:US
Practice Address - Phone:240-493-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty