Provider Demographics
NPI:1306431168
Name:EFEMWONYI F JESUOROBO
Entity type:Organization
Organization Name:EFEMWONYI F JESUOROBO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EFEMWONYI
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:JESUOROBO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:202-368-6707
Mailing Address - Street 1:6196 OXON HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3141
Mailing Address - Country:US
Mailing Address - Phone:202-368-6707
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 290
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3141
Practice Address - Country:US
Practice Address - Phone:202-368-6707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty