Provider Demographics
NPI:1194293530
Name:IBITOLA, KEHINDE WILLIAMS (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KEHINDE
Middle Name:WILLIAMS
Last Name:IBITOLA
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIONDI AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-1301
Mailing Address - Country:US
Mailing Address - Phone:973-493-0026
Mailing Address - Fax:
Practice Address - Street 1:10 BIONDI AVE
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1301
Practice Address - Country:US
Practice Address - Phone:973-493-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00866700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily