Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R196652 | MD |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R196652 | MD |
NPI | 1033781117 |
---|---|
Provider Name | Ifedayo Abiola-Matthew |
First Address | Baltimore, MD 21201-1544 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 02/11/2021 |