Provider Demographics
NPI:1588803423
Name:MBOUGE, JUDITH LEME (STNA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LEME
Last Name:MBOUGE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8835
Mailing Address - Country:US
Mailing Address - Phone:614-439-9826
Mailing Address - Fax:
Practice Address - Street 1:3368 OMEGA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-8835
Practice Address - Country:US
Practice Address - Phone:614-439-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322050710701376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide