Provider Demographics
NPI:1659632925
Name:MOJELOPE, GBEMISOLA ELIZABETH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GBEMISOLA
Middle Name:ELIZABETH
Last Name:MOJELOPE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:GBEMISOLA
Other - Middle Name:ELIZABETH
Other - Last Name:PETER-OLAKIIGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:134 OWENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9702
Mailing Address - Country:US
Mailing Address - Phone:410-867-4700
Mailing Address - Fax:
Practice Address - Street 1:134 OWENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778-9702
Practice Address - Country:US
Practice Address - Phone:410-867-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1034113363LP0808X
MDR162352363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2019049162OtherANCC
MDR162352OtherMARYLAND BOARD OF NURSING
MD2019049162OtherANCC