Provider Demographics
NPI:1053937573
Name:GREATER CHESAPEAKE HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:GREATER CHESAPEAKE HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEDEJI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:732-768-0386
Mailing Address - Street 1:1900 E NORTHERN PKWY STE T6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2120
Mailing Address - Country:US
Mailing Address - Phone:443-438-6893
Mailing Address - Fax:443-869-4437
Practice Address - Street 1:1900 E NORTHERN PKWY STE T6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2120
Practice Address - Country:US
Practice Address - Phone:443-438-6893
Practice Address - Fax:443-869-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty