Provider Demographics
NPI:1467148601
Name:MABASA-NCUBE, PATIENCE
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:MABASA-NCUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 LEGACY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6427
Mailing Address - Country:US
Mailing Address - Phone:317-353-4759
Mailing Address - Fax:
Practice Address - Street 1:1051 SOUTHFIELD DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2955
Practice Address - Country:US
Practice Address - Phone:317-406-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013787A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health