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General NPI Number Information
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NPI Number | 1053472357
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Entity Type | Individual
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Provider Name | MOSUNMOLA OLANIRETI AJENIKOKO RN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5714 PRESCOTT DR
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City | ARLINGTON
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State | TX
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Zip | 76018-2566
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Country | US
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Telephone | 817-467-0570
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Fax | 817-467-5592
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Provider Business Mailing Address
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Address Line | 5714 PRESCOTT DR
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City | ARLINGTON
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State | TX
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Zip | 76018-2566
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Country | US
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Telephone | 817-467-0570
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Fax | 817-467-5592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 009715
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License Number State | TX
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