Provider Demographics
NPI:1356636328
Name:AUDU, HABIBA (LPN)
Entity Type:Individual
Prefix:
First Name:HABIBA
Middle Name:
Last Name:AUDU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2508
Mailing Address - Country:US
Mailing Address - Phone:302-229-2824
Mailing Address - Fax:614-547-7992
Practice Address - Street 1:6161 BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2508
Practice Address - Country:US
Practice Address - Phone:302-229-2824
Practice Address - Fax:614-547-7992
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0010492164W00000X
OHAPRN.CNP.0033279363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMA7844182Medicaid