Basic Information
| Provider Information | |||||||||
| NPI: | 1508207440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURITALA | ||||||||
| FirstName: | AMINAT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5451 NEWTON ST | ||||||||
| Address2: | APR. 5 | ||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207841059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027058193 | ||||||||
| FaxNumber: | 2026355780 | ||||||||
| Practice Location | |||||||||
| Address1: | 1731 BUNKER HILL RD NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200173026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026355756 | ||||||||
| FaxNumber: | 2026355780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN1006267 | DC | Y | Nursing Service Providers | Licensed Practical Nurse | 251E00000X | HHA5934 | DC | N | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 055705600 | 05 | DE | MEDICAID |