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NPI Code Detail

MEDICARE: IBUKUN AJOKE FAGBUYI PMHNP

MEDICARE:   IBUKUN AJOKE FAGBUYI  PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner266910AZ

General Provider Information

NPI Number : 1174280549
Entity Type Code : Individual
Provider Name (Legal Business Name) : IBUKUN AJOKE FAGBUYI PMHNP
Provider Business Mailing Address
First Line : 9429 W OREGON AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85305-3352
Country : US
Telephone Number : 301-785-8946
Fax Number :
Provider Business Practice Location Address
First Line : 13838 S 46TH PL STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7805
Country : US
Telephone Number : 480-597-7903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2021
Last Update Date : 01/07/2022

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