Provider Demographics
NPI:1811464670
Name:AYOOLA, LUCY
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
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 1:2947 GRANITE VALE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4280
Mailing Address - Country:US
Mailing Address - Phone:646-217-8945
Mailing Address - Fax:
Practice Address - Street 1:2947 GRANITE VALE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4280
Practice Address - Country:US
Practice Address - Phone:646-217-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344390164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse