Healthcare Provider Details

I. General information

NPI: 1932468568
Provider Name (Legal Business Name): ABIMBOLA LATEEFAT JUNAID PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 JACQUE CT
BOWIE MD
20721-7241
US

IV. Provider business mailing address

507 JACQUE CT
BOWIE MD
20721-7241
US

V. Phone/Fax

Practice location:
  • Phone: 301-237-7431
  • Fax:
Mailing address:
  • Phone: 301-237-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR227202
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197307
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA0571
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1044909
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1006138
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023207226
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: