Provider Demographics
NPI:1679036107
Name:BANGHA TOHMUKUAH, GILBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:BANGHA TOHMUKUAH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6728
Mailing Address - Country:US
Mailing Address - Phone:716-632-1088
Mailing Address - Fax:
Practice Address - Street 1:30 S CAYUGA RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6728
Practice Address - Country:US
Practice Address - Phone:716-632-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723802367500000X
TX1072408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered