Provider Demographics
NPI:1013455898
Name:OMOBO, FOLUKE TITILAYO (CRNP-PMH)
Entity Type:Individual
Prefix:MRS
First Name:FOLUKE
Middle Name:TITILAYO
Last Name:OMOBO
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 1:17008 USHER PLACE
Mailing Address - Street 2:USHER PLACE
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:240-552-2390
Mailing Address - Fax:
Practice Address - Street 1:17008 USHER PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3443
Practice Address - Country:US
Practice Address - Phone:240-552-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033206163W00000X
MDR210277163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse