Provider Demographics
NPI:1912607409
Name:OSSAI, ABIMBOLA IDOWU (CRNP PMH)
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:IDOWU
Last Name:OSSAI
Suffix:
Gender:F
Credentials:CRNP PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PATAPSCO AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2692
Mailing Address - Country:US
Mailing Address - Phone:667-239-3144
Mailing Address - Fax:667-239-3146
Practice Address - Street 1:100 E PATAPSCO AVE STE E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2692
Practice Address - Country:US
Practice Address - Phone:667-239-3144
Practice Address - Fax:667-239-3146
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health