MEDICARE: MS. ACQUILLA LABUKU GBUNBLEE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	173910	NC

General Provider Information

NPI Number	:	1225954175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ACQUILLA LABUKU GBUNBLEE RN

Provider Business Mailing Address
First Line	:	333 SWANSON DR STE 126
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-8539
Country	:	US
Telephone Number	:	678-777-3857
Fax Number	:	678-990-9094

Provider Business Practice Location Address
First Line	:	333 SWANSON DR STE 126
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-8539
Country	:	US
Telephone Number	:	678-777-3857
Fax Number	:	678-990-9094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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