Provider Demographics
NPI:1275909848
Name:NIBAH, ABUNGEH LUAH (CFR, 8HR DODD CERTIF)
Entity Type:Individual
Prefix:MR
First Name:ABUNGEH
Middle Name:LUAH
Last Name:NIBAH
Suffix:
Gender:M
Credentials:CFR, 8HR DODD CERTIF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 JOYCE LANE, APT #4,
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237
Mailing Address - Country:US
Mailing Address - Phone:513-680-9216
Mailing Address - Fax:
Practice Address - Street 1:6100 JOYCE LANE, APT #4,
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237
Practice Address - Country:US
Practice Address - Phone:513-680-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3117326OtherCONTRACT NUMBER
OH0074062Medicaid