Provider Demographics
NPI:1275269797
Name:IGBEKOYI, BOLADALE
Entity Type:Individual
Prefix:
First Name:BOLADALE
Middle Name:
Last Name:IGBEKOYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3700
Mailing Address - Country:US
Mailing Address - Phone:682-248-9245
Mailing Address - Fax:
Practice Address - Street 1:2610 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3700
Practice Address - Country:US
Practice Address - Phone:682-248-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant