MODINAT OLUWATOYIN FAGBENRO


Address: 4105 Daylily Dr, Owings Mills, MD 21117-5034
Phone: 4108004471

MODINAT OLUWATOYIN FAGBENRO (NPI# 1063061034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1063061034
Entity Type Individual
Full Name MODINAT OLUWATOYIN FAGBENRO
Credential PMHNP-BC
Practice Address 4105 Daylily Dr
Owings Mills
MD 21117-5034
Practice Telephone 4108004471
Mailing Telephone 4108004471
Enumeration Date 2019-09-11
Last Update Date 2020-10-23
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
R210603 MD Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
8258 Veterans Hwy Ste 13, Millersville, MD 211081564 4107686088 4107686444

Office Location

Street Address 4105 DAYLILY DR
City OWINGS MILLS
State MD
Zip Code 21117-5034

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
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1811996895 Nora Richardsn-stewart Nurse Practitioner 4722 Eiderdown Ct, Owings Mills, MD 21117-6222 2005-07-20
1801412531 Homestead Health Services Inc. Nurse Practitioner 40 Windbluff Ct, Owings Mills, MD 21117-2471 2020-06-18
1396392452 Staywell Behavioral Health, LLC Nurse Practitioner 10451 Mill Run Cir Ste 400, Owings Mills, MD 21117-5594 2019-08-23
1467009423 Healthwell, Np LLC Nurse Practitioner 10451 Mill Run Cir Ste 400, Owings Mills, MD 21117-5594 2019-08-23
1467890855 Adeola Olotu Nurse Practitioner 7920 Mcdonogh Rd, Ste 201, Owings Mills, MD 21117 2013-06-07

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Competitor

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City OWINGS MILLS
Zip Code 21117

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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