=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801270889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MASOLANU LAWAL APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2015
-----------------------------------------------------
Last Update Date | 09/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1512 AZALEA DR
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-5532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-368-4305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1512 AZALEA DR
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-5532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-368-4305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00587400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------