Individual
MODUPE ADESOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-8242
Mailing address
1123 ABBEYWOOD RD, LOUISVILLE, KY 40222-4401
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3010425
KY
Other
Enumeration date
07/07/2016
Last updated
10/03/2019
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