Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00662300 | NJ |
NPI | 1033664685 |
---|---|
Provider Name | Lateef Ajanaku-Makun |
First Address | Union, NJ 07083-5129 |
Second Address | Union, NJ 07083-5129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 23/08/2016 |