Provider Demographics
NPI:1346896800
Name:SALAMI, LAWAL MOMODU
Entity Type:Individual
Prefix:
First Name:LAWAL
Middle Name:MOMODU
Last Name:SALAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 PUEBLO RDG
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8403
Mailing Address - Country:US
Mailing Address - Phone:817-658-3401
Mailing Address - Fax:
Practice Address - Street 1:3356 PUEBLO RDG
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8403
Practice Address - Country:US
Practice Address - Phone:817-658-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329145164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse