Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 119695 | GA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704180693 | MI |
NPI | 1033155486 |
---|---|
Provider Name | Mrs. Tujuana C Glenn Olajide |
First Address | Duluth, GA 30096-8070 |
Second Address | Duluth, GA 30096-8070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 27/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4704180693 | LICENSE (01) | MI |
4868152 | (05) | MA |