Provider Demographics
NPI:1255003448
Name:HUBENA, BONSITU GULUMA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BONSITU
Middle Name:GULUMA
Last Name:HUBENA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 GRANT HENRY DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8238
Mailing Address - Country:US
Mailing Address - Phone:614-943-5094
Mailing Address - Fax:
Practice Address - Street 1:6933 GRANT HENRY DR UNIT A
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8238
Practice Address - Country:US
Practice Address - Phone:614-943-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily