Healthcare Provider Details

I. General information

NPI: 1932819968
Provider Name (Legal Business Name): MOSUNMOLA ARIKE POPOOLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 CARLISLE BLVD NE STE 206
ALBUQUERQUE NM
87110-2862
US

IV. Provider business mailing address

2917 CARLISLE BLVD NE STE 206
ALBUQUERQUE NM
87110-2862
US

V. Phone/Fax

Practice location:
  • Phone: 505-456-8298
  • Fax: 505-273-6931
Mailing address:
  • Phone: 505-456-8298
  • Fax: 505-273-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0035566
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70763
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: