Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 32669 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | 32669 | TX |
N | 363LC1500X | Nurse Practitioner - Community Health | 32669 | TX |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 32669 | TX |
NPI | 1144868530 |
---|---|
Provider Name | Mary O Adegborioye |
First Address | Missouri City, TX 77489-3909 |
Second Address | Missouri City, TX 77489-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2019 |
Last Update Date | 16/12/2019 |