Individual
IDAAT BISOLA TIMBO-JALLOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7310 RITCHIE HWY STE 200, GLEN BURNIE, MD 21061-3065
(410) 446-7479
Mailing address
8285 W B AND A RD, SEVERN, MD 21144-2704
(410) 446-7479
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R209309
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841911500
—
MD
01
—
T-512-329-089-775
T-512-329-089-775
MD
Enumeration date
09/09/2022
Last updated
10/15/2024
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