Healthcare Provider Details

I. General information

NPI: 1174089510
Provider Name (Legal Business Name): NICODEMUS TOSAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3187 CROSSING HILL WAY
COLUMBUS OH
43219-7346
US

IV. Provider business mailing address

3187 CROSSING HILL WAY
COLUMBUS OH
43219-7346
US

V. Phone/Fax

Practice location:
  • Phone: 614-556-6903
  • Fax:
Mailing address:
  • Phone: 614-556-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.407841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: