Provider Demographics
NPI:1053633677
Name:ADEBIYI, IYABO O (RN)
Entity Type:Individual
Prefix:MRS
First Name:IYABO
Middle Name:O
Last Name:ADEBIYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STARK RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3613
Mailing Address - Country:US
Mailing Address - Phone:662-323-5033
Mailing Address - Fax:662-323-5053
Practice Address - Street 1:900 STARK RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3613
Practice Address - Country:US
Practice Address - Phone:662-323-5033
Practice Address - Fax:662-323-5053
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0123456163WC1500X, 163WD0400X, 163WN1003X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS192773OtherDSMT