Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 103113 | OK |
NPI | 1316432495 |
---|---|
Provider Name | Djufo Yimfor Ajiboye |
First Address | Oklahoma City, OK 73112-5555 |
Second Address | Oklahoma City, OK 73112-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 29/06/2018 |