Provider Demographics
NPI:1083162960
Name:ROTIMI, YETUNDE PRECIOUS (MSN, FNP-BC, PMHNP)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:PRECIOUS
Last Name:ROTIMI
Suffix:
Gender:F
Credentials:MSN, FNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL STE 400L2
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2268
Mailing Address - Country:US
Mailing Address - Phone:240-647-5702
Mailing Address - Fax:240-433-3269
Practice Address - Street 1:12909 5TH ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3608
Practice Address - Country:US
Practice Address - Phone:240-424-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205788363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR205788OtherMD RN NUMBER