Provider Demographics
NPI:1568988756
Name:NTUMNGIA, OLABISI
Entity Type:Individual
Prefix:
First Name:OLABISI
Middle Name:
Last Name:NTUMNGIA
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 1:4960 CROOKED CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3185
Mailing Address - Country:US
Mailing Address - Phone:240-486-7461
Mailing Address - Fax:
Practice Address - Street 1:8903 ASCOT LANE
Practice Address - Street 2:APT 11
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:240-486-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1568988756171M00000X
DCHHA12856374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide