Provider Demographics
NPI:1235688201
Name:AKINWUMI, PHILOMINAH KOFOWOROLA (NP)
Entity Type:Individual
Prefix:
First Name:PHILOMINAH
Middle Name:KOFOWOROLA
Last Name:AKINWUMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PHILOMINAH
Other - Middle Name:KOFOWOROLA
Other - Last Name:AKINWUMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2673 RAINY SPRING CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3304
Mailing Address - Country:US
Mailing Address - Phone:301-755-3822
Mailing Address - Fax:
Practice Address - Street 1:2673 RAINY SPRING CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3304
Practice Address - Country:US
Practice Address - Phone:301-755-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily