Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 26732 | MS |
Y | 207RN0300X | Nephrologist | 26732 | MS |
NPI | 1093057184 |
---|---|
Provider Name | Olusola Isikalu |
First Address | Pascagoula, MS 39567-1143 |
Second Address | Pascagoula, MS 39567-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 10/09/2019 |