Provider Demographics
NPI:1194183921
Name:MABINTY BUNDU
Entity Type:Organization
Organization Name:MABINTY BUNDU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:MABINTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-316-1905
Mailing Address - Street 1:3998 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3998 FOREST EDGE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1018
Practice Address - Country:US
Practice Address - Phone:614-316-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH414264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty