Healthcare Provider Details

I. General information

NPI: 1295005387
Provider Name (Legal Business Name): JARIATU BUNDU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 DENNISON AVE
COLUMBUS OH
43201-3201
US

IV. Provider business mailing address

1087 DENNISON AVE
COLUMBUS OH
43201-3201
US

V. Phone/Fax

Practice location:
  • Phone: 614-592-0757
  • Fax:
Mailing address:
  • Phone: 614-592-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0035624
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN137814
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: