Provider Demographics
NPI:1922882232
Name:OMOROGBE, COLLETTE ADESUWA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:ADESUWA
Last Name:OMOROGBE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 RIDGECREST WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6385
Mailing Address - Country:US
Mailing Address - Phone:410-905-2767
Mailing Address - Fax:
Practice Address - Street 1:1049 HILLEN ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5236
Practice Address - Country:US
Practice Address - Phone:410-905-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2023019800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health