Provider Demographics
NPI:1629557400
Name:IBIRONKE, FUNMILAYO OMOLARA
Entity Type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:OMOLARA
Last Name:IBIRONKE
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 1:2843 WELDONS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6067
Mailing Address - Country:US
Mailing Address - Phone:240-988-0442
Mailing Address - Fax:
Practice Address - Street 1:2843 WELDONS FOREST DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6067
Practice Address - Country:US
Practice Address - Phone:240-988-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner