Provider Demographics
NPI:1336854678
Name:LAWAL, MUSEDIQ YUSUF (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:MUSEDIQ
Middle Name:YUSUF
Last Name:LAWAL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5302
Mailing Address - Country:US
Mailing Address - Phone:301-996-6859
Mailing Address - Fax:
Practice Address - Street 1:4804 MONTGOMERY LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5302
Practice Address - Country:US
Practice Address - Phone:301-633-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166062363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health