Individual provider · NPI-1

Abisola E Abimbola

Nurse Practitioner, Family · Saint Louis, MO

NPI number1083440457
StatusActive
Last updated in NPPESDec 11, 2024

Details

NPI
1083440457
Entity type
Individual (NPI-1)
Name
Abisola E Abimbola
Sex
Female
Sole proprietor
Yes
Enumeration date
Sep 11, 2024
Certification date
Dec 11, 2024
Last updated
Dec 11, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family2024039031MOYes
163W00000X Registered Nurse2024037599MO
163W00000X Registered Nurse041.447832IL
363LF0000X Nurse Practitioner, Family209.030308IL

Practice location

7334 S Lindbergh Blvd
Saint Louis, MO 63125-4522

Phone 866-389-2727

Mailing address

6015 Staely Ave
Saint Louis, MO 63123-3460

Phone 732-763-0359

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