Provider Demographics
NPI:1447732425
Name:RAFIU, IYABO AMINAT
Entity type:Individual
Prefix:
First Name:IYABO
Middle Name:AMINAT
Last Name:RAFIU
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 1:3511 FOXCLIFF CT APT 203
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4909
Mailing Address - Country:US
Mailing Address - Phone:443-922-5886
Mailing Address - Fax:
Practice Address - Street 1:3511 FOXCLIFF CT APT 203
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4909
Practice Address - Country:US
Practice Address - Phone:443-922-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA13939374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide