Individual
MODINAT OLUWATOYIN FAGBENRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
22 W PADONIA RD STE C252, LUTHERVILLE TIMONIUM, MD 21093-2241
(410) 768-6088
(410) 768-6444
Mailing address
4105 DAYLILY DR, OWINGS MILLS, MD 21117-5034
(410) 800-4471
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R210603
MD
Other
Enumeration date
09/11/2019
Last updated
01/20/2026
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