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General NPI Number Information
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NPI Number | 1073155933
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Entity Type | Individual
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Provider Name | BAMIDELE GANIYU
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Gender | Male
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2101 CORONA RD STE 102
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City | COLUMBIA
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State | MO
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Zip | 65203-2582
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Country | US
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Telephone | 573-234-1800
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Fax | 573-234-1799
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Provider Business Mailing Address
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Address Line | 616 DEREK DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-6841
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Country | US
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Telephone | 314-960-4106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2020002143
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 83508
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2020002143
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License Number State | MO
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