Provider Demographics
NPI:1730351628
Name:AWOLOLA, KASUMA (RN)
Entity type:Individual
Prefix:MRS
First Name:KASUMA
Middle Name:
Last Name:AWOLOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KASUMA
Other - Middle Name:
Other - Last Name:MUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4807 GINGHAM CHECK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5379
Mailing Address - Country:US
Mailing Address - Phone:203-596-8970
Mailing Address - Fax:
Practice Address - Street 1:4807 GINGHAM CHECK CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5379
Practice Address - Country:US
Practice Address - Phone:203-596-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051010363LP0808X
NY514552163WM0705X
TX828792163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health