Provider Demographics
NPI:1598249740
Name:ABDULSALAM, MUTAWAKILU (RN)
Entity Type:Individual
Prefix:MR
First Name:MUTAWAKILU
Middle Name:
Last Name:ABDULSALAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHAWNEE PL
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1261
Mailing Address - Country:US
Mailing Address - Phone:161-741-3418
Mailing Address - Fax:
Practice Address - Street 1:9 SHAWNEE PL
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1261
Practice Address - Country:US
Practice Address - Phone:161-741-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse