Provider Demographics
NPI:1083457774
Name:OFODILE, DORIS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:OFODILE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 BALTIMORE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3232
Mailing Address - Country:US
Mailing Address - Phone:240-424-0622
Mailing Address - Fax:
Practice Address - Street 1:7305 BALTIMORE AVE STE 108
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3232
Practice Address - Country:US
Practice Address - Phone:240-424-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR243706163WP0807X, 163WP0200X, 163WP0808X, 163WW0000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care