Provider Demographics
NPI:1265290142
Name:GOBANA, BAYAN
Entity type:Individual
Prefix:
First Name:BAYAN
Middle Name:
Last Name:GOBANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1461
Mailing Address - Country:US
Mailing Address - Phone:612-636-9879
Mailing Address - Fax:
Practice Address - Street 1:559 EAGLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1461
Practice Address - Country:US
Practice Address - Phone:612-636-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion