Healthcare Provider Details

I. General information

NPI: 1962849745
Provider Name (Legal Business Name): ERICKA RAYE IGBONEGUN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11706 STONE MILL RD
CINCINNATI OH
45251-4126
US

IV. Provider business mailing address

11706 STONE MILL RD
CINCINNATI OH
45251-4126
US

V. Phone/Fax

Practice location:
  • Phone: 513-324-4868
  • Fax:
Mailing address:
  • Phone: 513-324-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14512
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.14512
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14512
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: