Provider Demographics
NPI:1083212443
Name:SUBBA, BUDDHA WOTI
Entity Type:Individual
Prefix:
First Name:BUDDHA
Middle Name:WOTI
Last Name:SUBBA
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 1:1112 22ND ST S APT 201
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2983
Mailing Address - Country:US
Mailing Address - Phone:701-936-4810
Mailing Address - Fax:
Practice Address - Street 1:1112 22ND ST S APT 201
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2983
Practice Address - Country:US
Practice Address - Phone:701-936-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant