Provider Demographics
NPI:1467116756
Name:OJO, ROSE OSAMUDIAMEN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:OSAMUDIAMEN
Last Name:OJO
Suffix:
Gender:
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:OSAMUDIAMEN
Other - Last Name:OBARISIAGBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2887
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-2887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 ROSEWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1388
Practice Address - Country:US
Practice Address - Phone:197-849-4816
Practice Address - Fax:978-233-3063
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339057163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult