Provider Demographics
NPI:1760789507
Name:RUNSEWE, ABIMBOLA A (DNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:A
Last Name:RUNSEWE
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 MILFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3328
Mailing Address - Country:US
Mailing Address - Phone:443-272-7858
Mailing Address - Fax:443-405-7237
Practice Address - Street 1:610 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3413
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:240-683-6203
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health