Provider Demographics
NPI:1326699380
Name:AGBEM, IBIJOKE TITILAYO (NP)
Entity Type:Individual
Prefix:MS
First Name:IBIJOKE
Middle Name:TITILAYO
Last Name:AGBEM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9718 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3882
Mailing Address - Country:US
Mailing Address - Phone:443-527-4028
Mailing Address - Fax:
Practice Address - Street 1:9718 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3882
Practice Address - Country:US
Practice Address - Phone:443-527-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF08190691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily