Provider Demographics
NPI:1073025458
Name:SOBO, ABOSEDE O (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:O
Last Name:SOBO
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 1:5603 KAVEH CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3681
Mailing Address - Country:US
Mailing Address - Phone:240-755-4903
Mailing Address - Fax:
Practice Address - Street 1:4340 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2315
Practice Address - Country:US
Practice Address - Phone:202-800-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197836363LF0000X
VAR197836363LF0000X
DC1024843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily