Active NPI
Omobola Sodimu
- Licensed Practical Nurse
- Plymouth Meeting, PA
National Provider Identifier
1104096742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LP40112
- Practice address
- 2250 Hickory Rd
Ste 240
Plymouth Meeting, PA 19462-1047 - Phone
- (800) 879-4471
- NPI assigned
- Mar 11, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LP40112 | MD | Primary |
Addresses
Primary practice location
2250 Hickory Rd
Ste 240
Plymouth Meeting, PA 19462-1047
Mailing address
4412 Burkes Promise Dr
Bowie, MD 20720-4697
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP40112 | MD | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205193600000",
"number": "1104096742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4412 BURKES PROMISE DR",
"city": "BOWIE",
"state": "MD",
"postal_code": "207204697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 HICKORY RD",
"address_2": "STE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194621047",
"telephone_number": "800-879-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODIMU",
"first_name": "OMOBOLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-11",
"last_updated": "2008-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MD",
"license": "LP40112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth Meeting, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.