Provider Demographics
NPI:1588289938
Name:LAWAL, MODINAT ABOLORE
Entity type:Individual
Prefix:
First Name:MODINAT
Middle Name:ABOLORE
Last Name:LAWAL
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 1:5002 MEADOWSIDE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2389
Mailing Address - Country:US
Mailing Address - Phone:516-451-8661
Mailing Address - Fax:
Practice Address - Street 1:5002 MEADOWSIDE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2389
Practice Address - Country:US
Practice Address - Phone:516-451-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX927815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse