Provider Demographics
NPI:1144208000
Name:MIJUMBI, OLIVIA BRIDGET (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:BRIDGET
Last Name:MIJUMBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLIVIA
Other - Middle Name:BRIDGET
Other - Last Name:NANZIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 550818
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-0818
Mailing Address - Country:US
Mailing Address - Phone:704-864-0303
Mailing Address - Fax:704-864-6070
Practice Address - Street 1:239 WILMOT DR STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4048
Practice Address - Country:US
Practice Address - Phone:704-864-0303
Practice Address - Fax:704-864-6070
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC810561334OtherWELLPATH SELECT INC
KY810561334OtherHEALTHNET OF CA
MA9259849OtherPHCS
NC810561334OtherSOUTHCARE PPO INC
NCA8078OtherMEDCOST
NC12-01098OtherUNITED HEALTHCARE
NC1322YOtherBLUECROSS BLUESHIELD
NC810561334OtherPRIMARY PHYSCIAIN CARE
NC810561334OtherHEALTHCARE SAVINGS
TN810561334OtherNORTH AMERICA ADMIN LP
NC2900124OtherAETNA
SC810561334OtherTRICARE
KS810561334OtherONE HEALTH
NC9554744001OtherCIGNA
NC891322YMedicaid
NC1322YOtherSTATE HEALTH PLAN NC
SC810561334OtherHEALTHSOURCE OF NC
NC810561334OtherPREMIER HEALTH SYSTEMS
NC810561334OtherPRIMARY PHYSCIAIN CARE
NC1322YOtherSTATE HEALTH PLAN NC