Provider Demographics
NPI:1972998086
Name:FOWORA, TEMITOPE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TEMITOPE
Middle Name:
Last Name:FOWORA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TEMITOPE
Other - Middle Name:OLUSOLA
Other - Last Name:ADEDOYIN - OSIFOWORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8502
Mailing Address - Country:US
Mailing Address - Phone:443-600-1038
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRMOUNT AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1972998086Medicaid