Provider Demographics
NPI:1962849745
Name:IGBONEGUN, ERICKA RAYE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:RAYE
Last Name:IGBONEGUN
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 1:11706 STONE MILL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-4126
Mailing Address - Country:US
Mailing Address - Phone:513-324-4868
Mailing Address - Fax:
Practice Address - Street 1:11706 STONE MILL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-4126
Practice Address - Country:US
Practice Address - Phone:513-324-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14512363LF0000X, 363LP0808X
OHAPRN.CNP.14512363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care