Healthcare Provider Details

I. General information

NPI: 1316300932
Provider Name (Legal Business Name): BIMPE M IGBENOBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 SNOW CLOUD LN
SILVER SPRING MD
20904-7201
US

IV. Provider business mailing address

3412 SNOW CLOUD LN
SILVER SPRING MD
20904-7201
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-0717
  • Fax: 202-808-2427
Mailing address:
  • Phone: 202-291-0717
  • Fax: 202-808-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1040264
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: