=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184587503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIODUN IDOWU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1931 GRAND WAY BLVD
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-683-4308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1931 GRAND WAY BLVD
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-683-4308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LPN500020616
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------