Provider Demographics
NPI:1245630193
Name:MBUVI, PHOEBE MUENI (PA-C)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:MUENI
Last Name:MBUVI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1298
Mailing Address - Country:US
Mailing Address - Phone:217-337-3852
Mailing Address - Fax:217-337-3853
Practice Address - Street 1:2718 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1298
Practice Address - Country:US
Practice Address - Phone:217-337-3852
Practice Address - Fax:217-337-3853
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005097363A00000X
MDC07630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant