Provider Demographics
NPI:1013472125
Name:SOWEMIMO, ABOSEDE EBUNOLUWA
Entity Type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:EBUNOLUWA
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 1:1719 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4566
Mailing Address - Country:US
Mailing Address - Phone:718-790-6657
Mailing Address - Fax:
Practice Address - Street 1:1719 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4566
Practice Address - Country:US
Practice Address - Phone:718-790-6657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY756355163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development