Provider Demographics
NPI:1316300932
Name:IGBENOBA, BIMPE M
Entity type:Individual
Prefix:
First Name:BIMPE
Middle Name:M
Last Name:IGBENOBA
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 1:3412 SNOW CLOUD LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7201
Mailing Address - Country:US
Mailing Address - Phone:202-291-0717
Mailing Address - Fax:202-808-2427
Practice Address - Street 1:3412 SNOW CLOUD LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7201
Practice Address - Country:US
Practice Address - Phone:202-291-0717
Practice Address - Fax:202-808-2427
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1040264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse