Provider Demographics
NPI:1700332673
Name:IDOWU, JOSEPHUS (RN)
Entity Type:Individual
Prefix:
First Name:JOSEPHUS
Middle Name:
Last Name:IDOWU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3738
Mailing Address - Country:US
Mailing Address - Phone:202-704-1090
Mailing Address - Fax:
Practice Address - Street 1:4608 SHARON RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-3738
Practice Address - Country:US
Practice Address - Phone:202-704-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCR1003138912163WP0808X
DC1700332673.163WC0400X, 163W00000X, 163WH0200X, 163WP0000X, 163WP0808X, 163WC2100X, 163WA2000X, 163WR0400X, 376G00000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)