MEDICARE: JOSEPHUS IDOWU RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R1003138912	DC
2	163WC0400X	Case Management Registered Nurse	1700332673.	DC
3	163W00000X	Registered Nurse	1700332673.	DC
4	163WH0200X	Home Health Registered Nurse	1700332673.	DC
5	163WP0000X	Pain Management Registered Nurse	1700332673.	DC
6	163WP0808X	Psychiatric/Mental Health Registered Nurse	1700332673.	DC
7	163WC2100X	Continence Care Registered Nurse	1700332673.	DC
8	163WA2000X	Administrator Registered Nurse	1700332673.	DC
9	163WR0400X	Rehabilitation Registered Nurse	1700332673.	DC
10	376G00000X	Nursing Home Administrator	1700332673.	DC
11	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	1700332673.	DC

General Provider Information

NPI Number	:	1700332673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHUS IDOWU RN

Provider Business Mailing Address
First Line	:	4608 SHARON RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-3738
Country	:	US
Telephone Number	:	202-704-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	4608 SHARON RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-3738
Country	:	US
Telephone Number	:	202-704-1090
Fax Number	:

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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