Provider Demographics
NPI:1285807917
Name:UMEOBI, SIMEON IFEANYI (LPN)
Entity type:Individual
Prefix:MR
First Name:SIMEON
Middle Name:IFEANYI
Last Name:UMEOBI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 KINGSWELL ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1952
Mailing Address - Country:US
Mailing Address - Phone:240-463-1240
Mailing Address - Fax:
Practice Address - Street 1:12222 KINGSWELL ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1952
Practice Address - Country:US
Practice Address - Phone:240-463-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP29845164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse