Dr. Olukorede Gisanrin
Nurse Practitioner, Family in Upper Marlboro, MD. Individual provider (NPI-1).
NPI number1548094840
StatusActive
Last updated in NPPESSep 10, 2024
Details
- NPI
- 1548094840
- Entity type
- Individual (NPI-1)
- Name
- Dr. Olukorede Gisanrin
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 28, 2024
- Certification date
- Sep 10, 2024
- Last updated
- Sep 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | R192641 | MD | Yes |
| 163W00000X | Registered Nurse | r192641 | MD |
Practice location
9600 Marilyn Ivy CtUpper Marlboro, MD 20772-4509
Phone 240-533-8778
Mailing address
9600 Marilyn Ivy CtUpper Marlboro, MD 20772-4509
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