MEDICARE: MS. ABIODUN ELIZABETH JAIYEOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R212534	MD

General Provider Information

NPI Number	:	1497146112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ABIODUN ELIZABETH JAIYEOLA

Provider Business Mailing Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	202-269-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	202-269-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2015
Last Update Date	:	11/23/2020

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