Provider Demographics
NPI:1528423704
Name:OSUNDE-OSAGIE, PHILOMENA
Entity type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:OSUNDE-OSAGIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7906 WINTERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3032
Mailing Address - Country:US
Mailing Address - Phone:240-393-9356
Mailing Address - Fax:
Practice Address - Street 1:7906 WINTERWOOD PL
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3032
Practice Address - Country:US
Practice Address - Phone:240-393-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1003646164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse