Healthcare Provider Details

I. General information

NPI: 1114342359
Provider Name (Legal Business Name): IBITOMI SODIPO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXENT PKWY STE 800
COLUMBIA MD
21044
US

IV. Provider business mailing address

10440 LITTLE PATUXENT PKWY STE 800
COLUMBIA MD
21044-3569
US

V. Phone/Fax

Practice location:
  • Phone: 443-518-0425
  • Fax:
Mailing address:
  • Phone:
  • Fax: 443-462-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR208611
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR208611
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: