Healthcare Provider Details

I. General information

NPI: 1235841495
Provider Name (Legal Business Name): MS. EBUNOLUWA O AKINDURO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

9670 SPRATLEY AVE
LAUREL MD
20723-1855
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR205165
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: