Individual
MODUPEOLA OLOLADE FAKUNLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6987 DALEHOLLOW DR, LITHONIA, GA 30058-7022
(404) 519-0373
Mailing address
6987 DALEHOLLOW DR, LITHONIA, GA 30058-7022
(404) 519-0373
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN172123
GA
163WH0200X
Home Health Registered Nurse
Primary
RN172123
GA
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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