Provider Demographics
NPI:1669985818
Name:ADEBIYI, IBIYEMI SAFURAT (REGISTERED NURSE/ADM)
Entity type:Individual
Prefix:
First Name:IBIYEMI
Middle Name:SAFURAT
Last Name:ADEBIYI
Suffix:
Gender:F
Credentials:REGISTERED NURSE/ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7539 COPPER KETTLE
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3936
Mailing Address - Country:US
Mailing Address - Phone:281-794-3546
Mailing Address - Fax:
Practice Address - Street 1:7539 COPPER KETTLE
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3936
Practice Address - Country:US
Practice Address - Phone:281-794-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX905073163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health