MEDICARE: HAJA DUMBUYA APRN

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.023910	OH

General Provider Information

NPI Number	:	1861951816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAJA DUMBUYA APRN

Provider Business Mailing Address
First Line	:	4330 NAVARRE AVE STE 103
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3587
Country	:	US
Telephone Number	:	419-691-7820
Fax Number	:	419-691-7593

Provider Business Practice Location Address
First Line	:	4330 NAVARRE AVE STE 103
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3587
Country	:	US
Telephone Number	:	196-917-8204
Fax Number	:	419-691-7593

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	05/01/2020

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Directions to “ HAJA DUMBUYA APRN” Practice Location

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