Individual
KHADIJATU KOROMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R181191
MD
363LP2300X
Primary Care Nurse Practitioner
Primary
F05210435
MD
Other
Enumeration date
06/02/2021
Last updated
03/25/2022
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