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General NPI Number Information
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NPI Number | 1669054607
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Entity Type | Individual
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Provider Name | AYODOLA O JATTO CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 4118 70TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2649
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Country | US
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Telephone | 240-713-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 4118 70TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2649
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Country | US
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Telephone | 240-713-4166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | R129336
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License Number State | MD
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