Provider Demographics
NPI:1740097732
Name:AYOOLA, MOYOSOLA MATILDA
Entity type:Individual
Prefix:
First Name:MOYOSOLA
Middle Name:MATILDA
Last Name:AYOOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 STIRRUP RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1465
Mailing Address - Country:US
Mailing Address - Phone:609-271-9460
Mailing Address - Fax:
Practice Address - Street 1:1544 N 61ST ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19151-4220
Practice Address - Country:US
Practice Address - Phone:215-877-1303
Practice Address - Fax:215-494-1099
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN778016163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health