Provider Demographics
NPI:1891202289
Name:OMONAYIN, MORIOHUNMUBO GRACE (CRNP)
Entity Type:Individual
Prefix:
First Name:MORIOHUNMUBO
Middle Name:GRACE
Last Name:OMONAYIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 ALLOWAY LN
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-6323
Mailing Address - Country:US
Mailing Address - Phone:301-256-6646
Mailing Address - Fax:
Practice Address - Street 1:8024 ALLOWAY LN
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-6323
Practice Address - Country:US
Practice Address - Phone:301-256-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine