Provider Demographics
NPI:1508207440
Name:MURITALA, AMINAT R (LPN)
Entity Type:Individual
Prefix:
First Name:AMINAT
Middle Name:R
Last Name:MURITALA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 NEWTON ST
Mailing Address - Street 2:APR. 5
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1059
Mailing Address - Country:US
Mailing Address - Phone:202-705-8193
Mailing Address - Fax:202-635-5780
Practice Address - Street 1:1731 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3026
Practice Address - Country:US
Practice Address - Phone:202-635-5756
Practice Address - Fax:202-635-5780
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006267164W00000X
DCHHA5934251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE055705600Medicaid