Provider Demographics
NPI:1841317401
Name:ILUPEJU, FAUSAT MODUPEOLA (RN)
Entity type:Individual
Prefix:MRS
First Name:FAUSAT
Middle Name:MODUPEOLA
Last Name:ILUPEJU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1917
Mailing Address - Country:US
Mailing Address - Phone:781-326-3696
Mailing Address - Fax:781-326-3076
Practice Address - Street 1:253 EAST ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1917
Practice Address - Country:US
Practice Address - Phone:781-326-3696
Practice Address - Fax:781-326-3076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201474163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704750OtherINDEPENDENT NURSE PROVIDE