Provider Demographics
NPI:1396239299
Name:ADVANCE MOBILE HEALTH SOLUTIONS
Entity type:Organization
Organization Name:ADVANCE MOBILE HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ADETIMBO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-722-9763
Mailing Address - Street 1:14028 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6845
Mailing Address - Country:US
Mailing Address - Phone:240-722-9763
Mailing Address - Fax:
Practice Address - Street 1:1374 HALSTEAD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-6006
Practice Address - Country:US
Practice Address - Phone:240-722-9763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194854363LF0000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty