Provider Demographics
NPI:1174280549
Name:FAGBUYI, IBUKUN AJOKE (PMHNP)
Entity type:Individual
Prefix:
First Name:IBUKUN
Middle Name:AJOKE
Last Name:FAGBUYI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:IBUKUN
Other - Middle Name:AJOKE
Other - Last Name:ONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9429 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3352
Mailing Address - Country:US
Mailing Address - Phone:301-785-8946
Mailing Address - Fax:
Practice Address - Street 1:13838 S 46TH PL STE 340
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7805
Practice Address - Country:US
Practice Address - Phone:480-597-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ266910363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health