Provider Demographics
NPI:1336626043
Name:OLUGBEMI, IDOWU OLUKEMI
Entity Type:Individual
Prefix:
First Name:IDOWU OLUKEMI
Middle Name:
Last Name:OLUGBEMI
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 1:528 MEADOWMIST WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1484
Mailing Address - Country:US
Mailing Address - Phone:240-360-9960
Mailing Address - Fax:
Practice Address - Street 1:528 MEADOWMIST WAY
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1484
Practice Address - Country:US
Practice Address - Phone:240-360-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide