Provider Demographics
NPI:1255689717
Name:ALLIBALOGUN, LINDA HASSAN (DNP, PMHNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:HASSAN
Last Name:ALLIBALOGUN
Suffix:
Gender:F
Credentials:DNP, PMHNP, FNP-BC
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:F
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, PMHNP
Mailing Address - Street 1:8890 MCDONOGH ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5397
Mailing Address - Country:US
Mailing Address - Phone:410-559-6121
Mailing Address - Fax:916-581-8678
Practice Address - Street 1:8890 MCDONOGH RD
Practice Address - Street 2:SUITE 208
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5397
Practice Address - Country:US
Practice Address - Phone:410-559-6121
Practice Address - Fax:916-581-8678
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175115363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD602310000Medicaid