Healthcare Provider Details

I. General information

NPI: 1649947938
Provider Name (Legal Business Name): TOKUNBO OBIDIRAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

IV. Provider business mailing address

907 CYPRESS POINT CIR
BOWIE MD
20721-2303
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN1046692
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: