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General NPI Number Information
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NPI Number | 1619571494
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Entity Type | Organization
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Legal Business Name | LAGOM ADVANCE HEALTH, LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 2411 CROFTON LN STE 11A
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City | CROFTON
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State | MD
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Zip | 21114-1337
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Country | US
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Telephone | 301-433-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 CROFTON LN
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City | CROFTON
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State | MD
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Zip | 21114-1304
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Country | US
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Telephone | 301-433-5511
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OWNER
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Name | MS. ABIODUN ELIZABETH JAIYEOLA
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Credential | FNP
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Telephone | 301-433-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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