Provider Demographics
NPI:1154115525
Name:PADONU, LANRE (CRNP PMH)
Entity type:Individual
Prefix:
First Name:LANRE
Middle Name:
Last Name:PADONU
Suffix:
Gender:
Credentials:CRNP PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 WATERLOO RD STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1943
Mailing Address - Country:US
Mailing Address - Phone:443-838-2400
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1943
Practice Address - Country:US
Practice Address - Phone:443-838-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215571363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health