Provider Demographics
NPI:1003377821
Name:AMUSAN, TEMITOPE OLUWAYEMISI
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:OLUWAYEMISI
Last Name:AMUSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10781 KITCHENER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1854
Mailing Address - Country:US
Mailing Address - Phone:240-280-9158
Mailing Address - Fax:
Practice Address - Street 1:10781 KITCHENER CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1854
Practice Address - Country:US
Practice Address - Phone:240-280-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14366376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide