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Individual

DEINMA IBULUBO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, FNP-BC

Contact information

Practice address
2054 TILLOTSON AVE, BRONX, NY 10475-1560
(718) 671-2100
Mailing address
1276 FULTON AVE RM 219, BRONX, NY 10456-3402
(718) 992-7669

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
647036
NY
363L00000X
Nurse Practitioner
SP023507
PA
363LF0000X
Family Nurse Practitioner
Primary
363715
NY

Other

Enumeration date
11/01/2012
Last updated
10/11/2022
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