Provider Demographics
NPI:1457535437
Name:OPEEWE-OJO, AUGUSTINA OLAJUMOKE (APRN)
Entity Type:Individual
Prefix:MS
First Name:AUGUSTINA
Middle Name:OLAJUMOKE
Last Name:OPEEWE-OJO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUGUSTINA
Other - Middle Name:OLAJUMOKE
Other - Last Name:OPEEWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MSN
Mailing Address - Street 1:2007 PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3678
Mailing Address - Country:US
Mailing Address - Phone:443-271-3013
Mailing Address - Fax:443-505-8627
Practice Address - Street 1:6 PARK CENTER CT STE 210
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5604
Practice Address - Country:US
Practice Address - Phone:410-413-1628
Practice Address - Fax:410-413-1644
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1010097363LA2200X
MDR131119363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414110500Medicaid