Healthcare Provider Details

I. General information

NPI: 1134088198
Provider Name (Legal Business Name): LAWRATU B JALLOH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 SINCLAIR RD STE 103
COLUMBUS OH
43229-5433
US

IV. Provider business mailing address

5394 TOWN HILL DR
CANAL WINCHESTER OH
43110-3803
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-7582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0040731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: