Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA.11568-NP | OH |
NPI | 1003128786 |
---|---|
Provider Name | Ms. Anta Fall Sow |
First Address | Whitehall, OH 43213-2441 |
Second Address | Westerville, OH 43082-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 10/01/2020 |