Provider Demographics
NPI:1174377881
Name:IKUJENYO, MOBOLAJI ADENIKE
Entity type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:ADENIKE
Last Name:IKUJENYO
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 1:528 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3423
Mailing Address - Country:US
Mailing Address - Phone:214-861-8080
Mailing Address - Fax:972-234-5665
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3423
Practice Address - Country:US
Practice Address - Phone:214-861-8080
Practice Address - Fax:972-234-5665
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178887164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse