Provider Demographics
NPI:1932819968
Name:POPOOLA, MOSUNMOLA ARIKE
Entity Type:Individual
Prefix:
First Name:MOSUNMOLA
Middle Name:ARIKE
Last Name:POPOOLA
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 1:11120 NE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1444
Mailing Address - Country:US
Mailing Address - Phone:206-823-1004
Mailing Address - Fax:
Practice Address - Street 1:3162 WILLIAMSON RD NW APT 204
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4353
Practice Address - Country:US
Practice Address - Phone:210-701-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health