MEDICARE: INE-IBIYE SAKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024175798	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024175798	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC006094	MD

General Provider Information

NPI Number	:	1053801654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INE-IBIYE SAKA

Provider Business Mailing Address
First Line	:	1518 PERRY ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2060
Country	:	US
Telephone Number	:	804-503-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 PERRY ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2060
Country	:	US
Telephone Number	:	804-503-5792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	02/21/2024

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Directions to “ INE-IBIYE SAKA ” Practice Location

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