Provider Demographics
NPI:1801407325
Name:NIBA, MARIAGORETTI LUMNWI (DNP)
Entity Type:Individual
Prefix:DR
First Name:MARIAGORETTI
Middle Name:LUMNWI
Last Name:NIBA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:225-302-2253
Mailing Address - Fax:
Practice Address - Street 1:1301 TAYLOR ST STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2946
Practice Address - Country:US
Practice Address - Phone:803-434-4790
Practice Address - Fax:803-434-4799
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214982363LF0000X
SC24275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6866Medicaid