Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2299476 | MA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2299476 | MA |
NPI | 1083001408 |
---|---|
Provider Name | Mumuni T. Daodu |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 21/04/2020 |