Healthcare Provider Details

I. General information

NPI: 1437848496
Provider Name (Legal Business Name): FUNMILAYO IGBINIGIE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FUNMI IGBINIGIE

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FULTON AVE
SACRAMENTO CA
95825-4500
US

IV. Provider business mailing address

9569 MAINLINE DR
ELK GROVE CA
95624-4466
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-3211
  • Fax:
Mailing address:
  • Phone: 916-548-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032450
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number744436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: