Provider Demographics
NPI:1174340186
Name:GANIYU, FOLAYEMI OLUBUSAYO (NP)
Entity type:Individual
Prefix:
First Name:FOLAYEMI
Middle Name:OLUBUSAYO
Last Name:GANIYU
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:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9203
Mailing Address - Country:US
Mailing Address - Phone:314-953-8788
Mailing Address - Fax:314-953-8798
Practice Address - Street 1:11155 DUNN RD STE 309E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6111
Practice Address - Country:US
Practice Address - Phone:314-953-8788
Practice Address - Fax:314-953-8798
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2024029786363LA2100X
MO20242029786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care