Individual
ABIMBOLA DATONYE IKETUBOSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 263-1619
Mailing address
PO BOX 95460, CLEVELAND, OH 44101-0033
(602) 581-6076
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
221449
AZ
363LF0000X
Family Nurse Practitioner
Primary
221449
AZ
363LF0000X
Family Nurse Practitioner
F08180855
AZ
Other
Enumeration date
02/14/2018
Last updated
12/15/2025
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