Provider Demographics
NPI:1861636979
Name:IBRAHEEM, FOLORUNSO (DNP, MBBS, CFNP)
Entity Type:Individual
Prefix:
First Name:FOLORUNSO
Middle Name:
Last Name:IBRAHEEM
Suffix:
Gender:M
Credentials:DNP, MBBS, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21639-1634
Mailing Address - Country:US
Mailing Address - Phone:410-482-4434
Mailing Address - Fax:949-862-8021
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:MD
Practice Address - Zip Code:21639-1634
Practice Address - Country:US
Practice Address - Phone:410-482-4434
Practice Address - Fax:949-862-8021
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9193808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI165-240-52-387-0OtherDRIVER LICENSE