| NPI | 1235749771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FOLASHADE KANIMODO CEO 410-900-8897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2025-07-09 |