Provider Demographics
NPI:1861783003
Name:TELLA, MOJISOLA S (RN)
Entity type:Individual
Prefix:
First Name:MOJISOLA
Middle Name:S
Last Name:TELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W BELLE PLAINE AVE
Mailing Address - Street 2:APT 611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2154
Mailing Address - Country:US
Mailing Address - Phone:773-564-3812
Mailing Address - Fax:773-549-7383
Practice Address - Street 1:820 W BELLE PLAINE AVE
Practice Address - Street 2:APT 611
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2154
Practice Address - Country:US
Practice Address - Phone:773-564-3812
Practice Address - Fax:773-549-7383
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies