Provider Demographics
NPI:1760243679
Name:RESTORATIVE WELLNESS AND PSYCHIATRY
Entity Type:Organization
Organization Name:RESTORATIVE WELLNESS AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOBI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:469-915-4211
Mailing Address - Street 1:61 ROUTE 27 STE 10
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1273
Mailing Address - Country:US
Mailing Address - Phone:603-858-8940
Mailing Address - Fax:
Practice Address - Street 1:61 ROUTE 27 STE 10
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1273
Practice Address - Country:US
Practice Address - Phone:469-915-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health