Healthcare Provider Details

I. General information

NPI: 1538526074
Provider Name (Legal Business Name): TITILOLA IYUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 MILLRACE CT APT A204
COLUMBIA MD
21045-5288
US

IV. Provider business mailing address

5900 MILLRACE CT APT A204
COLUMBIA MD
21045-5288
US

V. Phone/Fax

Practice location:
  • Phone: 443-562-4899
  • Fax:
Mailing address:
  • Phone: 443-562-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN1038620
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: