Organization
LIBERTY FAMILY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLAJI OLUGBOJA CRNP (OWNER)
(410) 301-6767
Entity
Organization
Contact information
Practice address
8515 LIBERTY RD STE B, RANDALLSTOWN, MD 21133-4832
(410) 301-6767
(410) 496-3121
Mailing address
8515 LIBERTY RD STE B, RANDALLSTOWN, MD 21133-4832
(410) 301-6767
(410) 496-3121
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R210237
LICENSE
MD
Enumeration date
08/27/2021
Last updated
12/21/2021
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