Provider Demographics
NPI:1003366857
Name:BUBONYE, EVAREST N I
Entity Type:Individual
Prefix:MR
First Name:EVAREST
Middle Name:N
Last Name:BUBONYE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 GOODMAN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4855
Mailing Address - Country:US
Mailing Address - Phone:513-394-9219
Mailing Address - Fax:
Practice Address - Street 1:1804 GOODMAN AVE APT 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4855
Practice Address - Country:US
Practice Address - Phone:513-394-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401365000312376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide