Provider Demographics
NPI:1437848496
Name:IGBINIGIE, FUNMILAYO (PMHNP)
Entity type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:
Last Name:IGBINIGIE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:FUNMI
Other - Middle Name:
Other - Last Name:IGBINIGIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9569 MAINLINE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4466
Mailing Address - Country:US
Mailing Address - Phone:916-548-0858
Mailing Address - Fax:
Practice Address - Street 1:900 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4500
Practice Address - Country:US
Practice Address - Phone:916-443-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA744436163W00000X
CA95032450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse