Provider Demographics
NPI:1538180013
Name:BAKUNAWA, MARIA LUISA (CNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:BAKUNAWA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GOODMAN ST
Mailing Address - Street 2:3 SOUTH
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-7372
Mailing Address - Fax:513-584-2605
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:3 SOUTH
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-7372
Practice Address - Fax:513-584-2605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4910P363L00000X
OHCOA08202NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3091603Medicaid
KY7100185180Medicaid
IN201071960Medicaid
KY7100185180Medicaid