Individual
MS. MODUPE BULURO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
151 BEACH 97TH ST FL 1, ROCKAWAY BEACH, NY 11693-1323
(917) 232-2082
Mailing address
151 BEACH 97TH ST FL 1, ROCKAWAY BEACH, NY 11693-1323
(917) 232-2082
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
618918-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
707-704-115
DRIVER LICENSE NUMBER
NY
Enumeration date
11/04/2021
Last updated
11/04/2021
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