Provider Demographics
NPI:1619273133
Name:SALAMI, MODUPE OLUYEMISI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MODUPE
Middle Name:OLUYEMISI
Last Name:SALAMI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BLACK WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-6606
Mailing Address - Country:US
Mailing Address - Phone:770-898-2745
Mailing Address - Fax:
Practice Address - Street 1:331 BLACK WILLOW CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-6606
Practice Address - Country:US
Practice Address - Phone:770-898-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily