Provider Demographics
NPI:1730762790
Name:OBIEFUNE, ROSEMARY (MSN, CRNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:OBIEFUNE
Suffix:
Gender:F
Credentials:MSN, CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 STONEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1912
Mailing Address - Country:US
Mailing Address - Phone:410-409-2141
Mailing Address - Fax:
Practice Address - Street 1:5084 DORSEY HALL DR STE 104
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7892
Practice Address - Country:US
Practice Address - Phone:410-772-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192643363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty