Provider Demographics
NPI:1730584202
Name:GBUGU, ADAOBI (PA-C)
Entity type:Individual
Prefix:
First Name:ADAOBI
Middle Name:
Last Name:GBUGU
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 1:15 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-3133
Mailing Address - Country:US
Mailing Address - Phone:207-768-4915
Mailing Address - Fax:
Practice Address - Street 1:15 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-3133
Practice Address - Country:US
Practice Address - Phone:207-768-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical