Provider Demographics
NPI:1033851209
Name:TAIWO, TITI
Entity Type:Individual
Prefix:
First Name:TITI
Middle Name:
Last Name:TAIWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 172ND STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7325
Mailing Address - Country:US
Mailing Address - Phone:612-386-2372
Mailing Address - Fax:
Practice Address - Street 1:5370 172ND STREET WEST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55024-7325
Practice Address - Country:US
Practice Address - Phone:612-386-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily