Individual
MODUPE FADOJUTIMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1 MAGNOLIA DR, LA PLATA, MD 20646-9357
(301) 934-4001
Mailing address
1 MAGNOLIA DR, LA PLATA, MD 20646-9357
(301) 934-4001
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
R194540
MD
Other
Enumeration date
03/13/2019
Last updated
03/13/2019
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