Provider Demographics
NPI:1689157927
Name:MBUH, GERMAINE
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:MBUH
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 1:304 4TH AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2598
Mailing Address - Country:US
Mailing Address - Phone:641-814-6161
Mailing Address - Fax:
Practice Address - Street 1:304 4TH AVE APT 28
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2598
Practice Address - Country:US
Practice Address - Phone:641-814-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA147037164W00000X
IAG172305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse