MEDICARE: BIMPE M IGBENOBA

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	163W00000X	Registered Nurse	RN1040264	DC

General Provider Information

NPI Number	:	1316300932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIMPE M IGBENOBA

Provider Business Mailing Address
First Line	:	3412 SNOW CLOUD LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7201
Country	:	US
Telephone Number	:	202-291-0717
Fax Number	:	202-808-2427

Provider Business Practice Location Address
First Line	:	3412 SNOW CLOUD LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7201
Country	:	US
Telephone Number	:	202-291-0717
Fax Number	:	202-808-2427

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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Directions to “ BIMPE M IGBENOBA ” Practice Location

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