Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | R167650 | MD |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R167650 | MD |
NPI | 1033340278 |
---|---|
Provider Name | Dr. Modupe Togun |
First Address | Windsor Mill, MD 21244-2023 |
Second Address | Windsor Mill, MD 21244-2023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033777300 | (05) | MD |