Provider Demographics
NPI:1316539810
Name:NEWBOLD, SIMIDELE
Entity Type:Individual
Prefix:
First Name:SIMIDELE
Middle Name:
Last Name:NEWBOLD
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 1:902 HALL STATION DR APT 102
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6013
Mailing Address - Country:US
Mailing Address - Phone:202-981-9894
Mailing Address - Fax:
Practice Address - Street 1:902 HALL STATION DR APT 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-6013
Practice Address - Country:US
Practice Address - Phone:202-981-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00177024376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide