MEDICARE: ABOSEDE EBUNOLUWA SOWEMIMO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1600X	Continuing Education/Staff Development Registered Nurse	756355	NY

General Provider Information

NPI Number	:	1013472125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABOSEDE EBUNOLUWA SOWEMIMO

Provider Business Mailing Address
First Line	:	1719 STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4566
Country	:	US
Telephone Number	:	718-790-6657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4566
Country	:	US
Telephone Number	:	718-790-6657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2019
Last Update Date	:	02/02/2019

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