Mofoluke Sobowale, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R167280 Issued in MD

Practice address

1863 Mount Denali Dr
Woodstock, MD 21163-1483

Phone

(443) 854-8563

NPI assigned

Sep 14, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Chosen Pediatrics Clinic LLC

  • Family Nurse Practitioner
  • Glen Burnie, MD
  • NPI 1649102294
  NPD Authorized official

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1588334346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1863 MOUNT DENALI DR",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631483",
            "telephone_number": "443-854-8563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1863 MOUNT DENALI DR",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631483",
            "telephone_number": "443-854-8563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBOWALE",
        "first_name": "MOFOLUKE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R167280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyra Reed
• Rest Assured, P.a.
• Christopher Alexander Romanowski, CRNA
• Siri Shaw, LCPC
• Jill Skelton, LCSW-R
• Aroon Suansilppongse, M.D.
• Truvit Primary Care
• Anna Varley, M.S. CCC-SLP
• Deborah Ann Vir, MFT
• Walter M. Mazzella, D.D.S., P.C.

• Family Nurse Practitioner in Woodstock, MD
• Providers in Woodstock, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.