Healthcare Provider Details

I. General information

NPI: 1891576062
Provider Name (Legal Business Name): ABAYOMI OLUMIDE OLORUNFEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SCOTCH PINE DR
BOWIE MD
20721-2789
US

IV. Provider business mailing address

1615 SCOTCH PINE DR
BOWIE MD
20721-2789
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-1573
  • Fax:
Mailing address:
  • Phone: 240-486-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1039130
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: