Individual
OLAWALE NURUDEEN MOYOSORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 HIGHWAY 89 NORTH, PRESCOTT, AZ 86313
(928) 445-4860
Mailing address
181 WHIPPLE ST, PRESCOTT, AZ 86301-1705
(480) 719-6554
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
262277
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP143491
TX
Other
Enumeration date
05/24/2021
Last updated
01/28/2022
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