Provider Demographics
NPI:1144737578
Name:IBEGBU, NKIRU (RN)
Entity Type:Individual
Prefix:
First Name:NKIRU
Middle Name:
Last Name:IBEGBU
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 1:6075 VIXEN CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4755
Mailing Address - Country:US
Mailing Address - Phone:734-218-0740
Mailing Address - Fax:
Practice Address - Street 1:1515 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-275-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse