Healthcare Provider Details

I. General information

NPI: 1437380896
Provider Name (Legal Business Name): MAUREEN O IGBINOBA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 WASHINGTON VILLAGE DR SUITE 120
CENTERVILLE OH
45459-4056
US

IV. Provider business mailing address

2912 SPRINGBORO W SUITE 201
MORAINE OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-7411
  • Fax: 937-396-0045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.12416-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: