Provider Demographics
NPI:1477286698
Name:GBADYU, PURSEH TAMAIKA
Entity Type:Individual
Prefix:
First Name:PURSEH
Middle Name:TAMAIKA
Last Name:GBADYU
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 1:3701 N MARLEON DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-7801
Mailing Address - Country:US
Mailing Address - Phone:317-306-8542
Mailing Address - Fax:
Practice Address - Street 1:3701 N MARLEON DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-7801
Practice Address - Country:US
Practice Address - Phone:317-306-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program