MEDICARE: DR. ABIMBOLA A RUNSEWE DNP, 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	R176584	MD

General Provider Information

NPI Number	:	1760789507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABIMBOLA A RUNSEWE DNP, PMHNP

Provider Business Mailing Address
First Line	:	3605 MILFORD MILL RD
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-3329
Country	:	US
Telephone Number	:	443-272-7858
Fax Number	:	443-405-7237

Provider Business Practice Location Address
First Line	:	3605 MILFORD MILL RD
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-3329
Country	:	US
Telephone Number	:	443-272-7858
Fax Number	:	443-405-7237

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	06/24/2026

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