Provider Demographics
NPI:1538750559
Name:BAMGBOSE, LILIAN ENIBOKUN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ENIBOKUN
Last Name:BAMGBOSE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 MEADE AVE STE 5B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7810
Mailing Address - Country:US
Mailing Address - Phone:725-333-2411
Mailing Address - Fax:702-952-5257
Practice Address - Street 1:800 N RAINBOW BLVD STE 215
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:800-950-0026
Practice Address - Fax:702-952-5257
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1028759363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty