Provider Demographics
NPI:1174834667
Name:LADIPO, MUSBAU Y (DIPLOMA NURSING)
Entity Type:Individual
Prefix:
First Name:MUSBAU
Middle Name:Y
Last Name:LADIPO
Suffix:
Gender:F
Credentials:DIPLOMA NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5433
Mailing Address - Country:US
Mailing Address - Phone:347-433-2437
Mailing Address - Fax:
Practice Address - Street 1:10802 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5433
Practice Address - Country:US
Practice Address - Phone:405-371-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299811-1164W00000X
TX353777164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse