Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5015648 | NC |
N | 363LA2100X | Nurse Practitioner - Acute Care | 5015648 | NC |
NPI | 1033861117 |
---|---|
Provider Name | Oluwatoyin Alaba Fadeyi |
First Address | Winston Salem, NC 27103-6074 |
Second Address | Winston Salem, NC 27103-1522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 03/02/2022 |