MEDICARE: MOMUDAT B SALISU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.143471.MEDS-IV	OH

General Provider Information

NPI Number	:	1861912925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOMUDAT B SALISU

Provider Business Mailing Address
First Line	:	396 AUDREY DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1717
Country	:	US
Telephone Number	:	216-375-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	396 AUDREY DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1717
Country	:	US
Telephone Number	:	216-375-7040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	07/21/2022

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Directions to “ MOMUDAT B SALISU ” Practice Location

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