Provider Demographics
NPI:1760793475
Name:FAYOMI, BESSIE MODUPE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:BESSIE
Middle Name:MODUPE
Last Name:FAYOMI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 RED MINE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8800
Mailing Address - Country:US
Mailing Address - Phone:972-522-0772
Mailing Address - Fax:
Practice Address - Street 1:3519 RED MINE LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8800
Practice Address - Country:US
Practice Address - Phone:972-522-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide