Provider Demographics
NPI:1700341856
Name:MUMUNEY, QUEEN BISOLA O (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:QUEEN BISOLA
Middle Name:O
Last Name:MUMUNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 SCAGGS RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4208
Mailing Address - Country:US
Mailing Address - Phone:301-442-5109
Mailing Address - Fax:
Practice Address - Street 1:800 ALABASTER CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1872
Practice Address - Country:US
Practice Address - Phone:301-442-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175488163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse