Provider Demographics
NPI:1891559746
Name:OGUNMAKINWA, DORIS (PMHNP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:OGUNMAKINWA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14109 BRANDYWINE RD UNIT 953
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-0187
Mailing Address - Country:US
Mailing Address - Phone:202-744-2347
Mailing Address - Fax:
Practice Address - Street 1:14109 BRANDYWINE RD UNIT 753
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-0180
Practice Address - Country:US
Practice Address - Phone:202-744-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health