Provider Demographics
NPI:1497593628
Name:SHALUJO, BOLANLE (RN)
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:SHALUJO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 STATE HIGHWAY 249 STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1132
Mailing Address - Country:US
Mailing Address - Phone:346-758-0232
Mailing Address - Fax:
Practice Address - Street 1:10947 SILVER CANOE DR
Practice Address - Street 2:
Practice Address - City:BEASLEY
Practice Address - State:TX
Practice Address - Zip Code:77417-0294
Practice Address - Country:US
Practice Address - Phone:346-758-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN76494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse