Provider Demographics
NPI:1629534342
Name:SOWEMIMO, TOYOSI OLABISI
Entity Type:Individual
Prefix:
First Name:TOYOSI
Middle Name:OLABISI
Last Name:SOWEMIMO
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 1:6823C RIVERDALE RD APT C202
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3818
Mailing Address - Country:US
Mailing Address - Phone:240-357-1222
Mailing Address - Fax:
Practice Address - Street 1:6823C RIVERDALE RD APT C202
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3818
Practice Address - Country:US
Practice Address - Phone:240-357-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14241374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide