Provider Demographics
NPI:1669207627
Name:ADEGBOYEGA, IBIJOKE HELEN (CRNP)
Entity type:Individual
Prefix:
First Name:IBIJOKE
Middle Name:HELEN
Last Name:ADEGBOYEGA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8376 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1702
Mailing Address - Country:US
Mailing Address - Phone:267-770-6000
Mailing Address - Fax:
Practice Address - Street 1:8376 LANGDON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1702
Practice Address - Country:US
Practice Address - Phone:267-770-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health