Provider Demographics
NPI:1538642301
Name:BAMIGBOYE, GENEVIVE NKIRU (FNP)
Entity Type:Individual
Prefix:
First Name:GENEVIVE
Middle Name:NKIRU
Last Name:BAMIGBOYE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4982 WINDPOWER WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7501
Mailing Address - Country:US
Mailing Address - Phone:713-416-9470
Mailing Address - Fax:
Practice Address - Street 1:8113 HARFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5790
Practice Address - Country:US
Practice Address - Phone:410-882-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR185825Medicaid