Individual
MODUPE KOLAWOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
681 CLARKSON AVE, BROOKLYN, NY 11203-2199
(718) 221-7772
Mailing address
681 CLARKSON AVE, BROOKLYN, NY 11203-2199
(718) 221-7772
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
489040
NY
Other
Enumeration date
10/08/2019
Last updated
10/08/2019
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