Provider Demographics
NPI:1568168540
Name:AKINYEMI, MARIAM MOJISOLA
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:MOJISOLA
Last Name:AKINYEMI
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 1:3205 W GLENREED CT
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1579
Mailing Address - Country:US
Mailing Address - Phone:124-089-8516
Mailing Address - Fax:
Practice Address - Street 1:2288 BLUE WATER BLVD STE 317
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3301
Practice Address - Country:US
Practice Address - Phone:443-302-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00202202374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide