MEDICARE: TEMITOPE ABIOLA DAWODU DNP, FNP, PMHNP- BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP4516	MN
2	363LF0000X	Family Nurse Practitioner	CNP 4516	MN

General Provider Information

NPI Number	:	1306296967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMITOPE ABIOLA DAWODU DNP, FNP, PMHNP- BC

Provider Business Mailing Address
First Line	:	4570 CHURCHILL ST STE 140
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-2274
Country	:	US
Telephone Number	:	612-517-1293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 CHURCHILL ST STE 140
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-2274
Country	:	US
Telephone Number	:	612-517-1293
Fax Number	:	612-349-2790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	01/11/2023

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