Healthcare Provider Details

I. General information

NPI: 1841105723
Provider Name (Legal Business Name): BRIGITTE BANGUDI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HARMON AVE
COLUMBUS OH
43223-3829
US

IV. Provider business mailing address

3195 OMEGA DR
COLUMBUS OH
43231-8807
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-5960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0040206
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: