Healthcare Provider Details

I. General information

NPI: 1356636328
Provider Name (Legal Business Name): HABIBA AUDU LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 BUSCH BLVD
COLUMBUS OH
43229-2508
US

IV. Provider business mailing address

6161 BUSCH BLVD
COLUMBUS OH
43229-2508
US

V. Phone/Fax

Practice location:
  • Phone: 302-229-2824
  • Fax: 614-547-7992
Mailing address:
  • Phone: 302-229-2824
  • Fax: 614-547-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033279
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL2-0010492
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: