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Individual

MUTIAT O. POPOOLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
15518 KENNETT SQUARE WAY, BRANDYWINE, MD 20613-6239
(240) 988-3779
Mailing address
337 BRIGHTSEAT RD STE 201, HYATTSVILLE, MD 20785-4736
(240) 988-3779

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R205702
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NONE
OPTIONAL
Enumeration date
09/21/2020
Last updated
12/21/2020
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