Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP130551 | TX |
NPI | 1003268558 |
---|---|
Provider Name | Mrs. Bolanle Adetutu Toriola |
First Address | Katy, TX 77494-1778 |
Second Address | Katy, TX 77494-1778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |