Provider Demographics
NPI:1811589385
Name:HUBENA, MERGITU GULUMA
Entity Type:Individual
Prefix:
First Name:MERGITU
Middle Name:GULUMA
Last Name:HUBENA
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 1:745 MANCHESTER CIR N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2082
Mailing Address - Country:US
Mailing Address - Phone:614-843-0463
Mailing Address - Fax:
Practice Address - Street 1:1990 HARMON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3829
Practice Address - Country:US
Practice Address - Phone:614-445-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner