Individual
BAMIDELE GANIYU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
(573) 234-1799
Mailing address
616 DEREK DR, WENTZVILLE, MO 63385-6841
(314) 960-4106
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2020002143
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020002143
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
83508
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/11/2019
Last updated
11/19/2024
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