Healthcare Provider Details

I. General information

NPI: 1811617681
Provider Name (Legal Business Name): MUNRUDEEN MOSURO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 55TH AVE
HYATTSVILLE MD
20784-1152
US

IV. Provider business mailing address

3600 55TH AVE
HYATTSVILLE MD
20784-1152
US

V. Phone/Fax

Practice location:
  • Phone: 202-427-8057
  • Fax: 410-946-2010
Mailing address:
  • Phone: 202-427-8057
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00038305
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: