Provider Demographics
NPI:1487888285
Name:BAMIBE, JIZELL
Entity type:Individual
Prefix:MRS
First Name:JIZELL
Middle Name:
Last Name:BAMIBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 TOWNE CROSSING BLVD
Mailing Address - Street 2:1203
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3913
Mailing Address - Country:US
Mailing Address - Phone:347-322-2611
Mailing Address - Fax:817-466-3313
Practice Address - Street 1:1751 TOWNE CROSSING BLVD
Practice Address - Street 2:1203
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3913
Practice Address - Country:US
Practice Address - Phone:347-322-2611
Practice Address - Fax:817-466-3313
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health