Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN1038620 | DC |
NPI | 1538526074 |
---|---|
Provider Name | Titilola Iyun |
First Address | Columbia, MD 21045-5288 |
Second Address | Columbia, MD 21045-5288 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2016 |
Last Update Date | 27/01/2016 |