Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 0024171618 | VA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | R142566 | MD |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN68175 | DC |
NPI | 1013156181 |
---|---|
Provider Name | Mrs. Oluwatoyin Clara Adisa |
First Address | Pikesville, MD 21208-2430 |
Second Address | Baltimore, MD 21213-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 11/03/2019 |