Healthcare Provider Details

I. General information

NPI: 1942164470
Provider Name (Legal Business Name): MOMOLU MOSES JOHNSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

27 WINBURNE DR
NEW CASTLE DE
19720-3721
US

V. Phone/Fax

Practice location:
  • Phone: 267-312-0377
  • Fax:
Mailing address:
  • Phone: 267-312-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN744724
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0072090
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: