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General NPI Number Information
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NPI Number | 1790394922
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Entity Type | Individual
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Provider Name | MAGDALENE BAMBO PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 11807 ALLISONVILLE RD # 508
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City | FISHERS
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State | IN
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Zip | 46038-2313
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Country | US
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Telephone | 317-286-6778
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Fax | 317-981-1925
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Provider Business Mailing Address
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Address Line | 8470 ALLISON POINTE BLVD STE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4368
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71010275A
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License Number State | IN
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