Provider Demographics
NPI:1750964813
Name:AKANDE, OMOWUMI
Entity type:Individual
Prefix:
First Name:OMOWUMI
Middle Name:
Last Name:AKANDE
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 1:5603 RICHMANOR TER UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4712
Mailing Address - Country:US
Mailing Address - Phone:646-427-0466
Mailing Address - Fax:
Practice Address - Street 1:11445 COMPAQ CENTER WEST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1433
Practice Address - Country:US
Practice Address - Phone:281-429-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146175363LF0000X
MDR231252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily