Provider Demographics
NPI:1174024566
Name:IJIYEMI, BEATRICE TAIWO (CRNP)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:TAIWO
Last Name:IJIYEMI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BEATRICE
Other - Middle Name:TAIWO
Other - Last Name:ADEFALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-3467
Mailing Address - Fax:717-851-3498
Practice Address - Street 1:605 S GEORGE ST STE 200
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-3161
Practice Address - Country:US
Practice Address - Phone:717-851-3467
Practice Address - Fax:717-851-3498
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018323363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology