Provider Demographics
NPI:1841789146
Name:MOJIBOLA, VICTORIA (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MOJIBOLA
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 1:1324 DEANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6004
Mailing Address - Country:US
Mailing Address - Phone:443-939-6585
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR STE 207
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7525
Practice Address - Country:US
Practice Address - Phone:443-939-6585
Practice Address - Fax:443-841-7680
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193306363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health