MEDICARE: ABIOLA MUMUNI-ABASS PMHNP

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	R207134	MD

General Provider Information

NPI Number	:	1366081903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIOLA MUMUNI-ABASS PMHNP

Provider Business Mailing Address
First Line	:	2600 BALLSTON CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-3281
Country	:	US
Telephone Number	:	301-256-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 BALLSTON CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-3281
Country	:	US
Telephone Number	:	301-256-1546
Fax Number	:

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

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	12/30/2019

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