Provider Demographics
NPI:1750989042
Name:AGBOIFO, OSEREME NORA (NP)
Entity type:Individual
Prefix:
First Name:OSEREME
Middle Name:NORA
Last Name:AGBOIFO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 SERVICE BERRY WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-6052
Mailing Address - Country:US
Mailing Address - Phone:832-606-9675
Mailing Address - Fax:
Practice Address - Street 1:200 EJOPPA RD SUITE 106
Practice Address - Street 2:
Practice Address - City:TOWNSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-337-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197691363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health