Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F1116618 | OH |
NPI | 1073050316 |
---|---|
Provider Name | Mr. Kwadwo Manu Otchere |
First Address | Columbus, OH 43231-4033 |
Second Address | Whitehall, OH 43213-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2017 |
Last Update Date | 25/01/2017 |