Individual
TOLULOPE OLUFUNMILOLA FASOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9114 MERRICK BLVD, JAMAICA, NY 11432-5247
(718) 408-7178
Mailing address
9114 MERRICK BLVD, JAMAICA, NY 11432-5247
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
741615
NY
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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