Provider Demographics
NPI:1366081903
Name:MUMUNI-ABASS, ABIOLA (PMHNP)
Entity type:Individual
Prefix:
First Name:ABIOLA
Middle Name:
Last Name:MUMUNI-ABASS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BALLSTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3281
Mailing Address - Country:US
Mailing Address - Phone:301-256-1546
Mailing Address - Fax:
Practice Address - Street 1:2600 BALLSTON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3281
Practice Address - Country:US
Practice Address - Phone:301-256-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207134363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health