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General NPI Number Information
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NPI Number | 1073105136
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Entity Type | Individual
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Provider Name | TOLULOPE IDOWU MOSES
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Gender | Female
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 1615 KENILWORTH AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-2010
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Country | US
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Telephone | 202-588-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 GREEN APPLE TURN
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-4423
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Country | US
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Telephone | 240-413-7357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA14339
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License Number State | DC
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