Provider Demographics
NPI:1689290017
Name:FALUBI, MODUPEOLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MODUPEOLA
Middle Name:
Last Name:FALUBI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 N BEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3293
Mailing Address - Country:US
Mailing Address - Phone:816-456-2557
Mailing Address - Fax:
Practice Address - Street 1:5741 N BEAMAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3293
Practice Address - Country:US
Practice Address - Phone:816-456-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019072717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health