Individual provider Active NPI

Omobolanle M. Adenuga, CRNP-F

  • Nurse Practitioner
  • Ellicott City, MD
National Provider Identifier
1336796465
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R214177 Issued in MD
Practice address
3565 Ellicott Mills Dr Ste B2
Ellicott City, MD 21043-4549
Phone
(443) 282-3413
Fax
(443) 276-7475
NPI assigned
Aug 22, 2019
Last updated
Jan 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R214177 MD Primary

Addresses

Primary practice location

3565 Ellicott Mills Dr Ste B2
Ellicott City, MD 21043-4549

Mailing address

3565 Ellicott Mills Dr Ste B2
Ellicott City, MD 21043-4549
Phone (443) 272-5506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, VA, DC3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200401001874 MD Practitioner - Nurse Practitioner 6800225533 Reassigns benefits to 4 organizations
I20210324002695 VA Practitioner - Nurse Practitioner 6800225533 Reassigns benefits to 1 organization
I20210325001345 DC Practitioner - Nurse Practitioner 6800225533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Memorial Ave
Westminster, MD 21157-5726
Phone (410) 871-6700

3565 Ellicott Mills Dr
Suite B2
Ellicott City, MD 21043-4549
Phone (443) 282-3413

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R214177MDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mep Observation Services LLC Nurse Practitioner CurrentSince Feb 11, 2026 Accepting new patients
CRH MD Management LLC CurrentSince Jul 3, 2024 Accepting new patients
Mep Observation Services LLC CurrentSince Feb 11, 2026 Accepting new patients
CRH MD Management LLC CurrentSince Jul 3, 2024 Accepting new patients
CRH MD Management, LLC CurrentSince Jul 3, 2024 Accepting new patients

Locations

590 Lanier Ave W
Fayetteville, GA 30214

14421 Baltimore Ave
Laurel, MD 20707
Phone (240) 786-6684

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

11804 Reisterstown Rd
Reisterstown, MD 21136
Phone (410) 870-5094

14090 Hg Trueman Rd
Ste 1300
Solomons, MD 20688
Phone (410) 394-2800

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1336796465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3565 ELLICOTT MILLS DR STE B2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434549",
            "telephone_number": "443-272-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3565 ELLICOTT MILLS DR STE B2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434549",
            "telephone_number": "443-282-3413",
            "fax_number": "443-276-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADENUGA",
        "first_name": "OMOBOLANLE",
        "middle_name": "M.",
        "credential": "CRNP-F",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-22",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R214177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.