Provider Demographics
NPI:1619571494
Name:LAGOM ADVANCE HEALTH, LLC
Entity Type:Organization
Organization Name:LAGOM ADVANCE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JAIYEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:301-433-5511
Mailing Address - Street 1:2411 CROFTON LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1304
Mailing Address - Country:US
Mailing Address - Phone:301-433-5511
Mailing Address - Fax:
Practice Address - Street 1:2411 CROFTON LN STE 11A
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1337
Practice Address - Country:US
Practice Address - Phone:301-433-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty