Healthcare Provider Details

I. General information

NPI: 1265781512
Provider Name (Legal Business Name): MARY NKANSAH-WIAFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 JEFFERSON AVE STE 201
COLUMBUS OH
43215-1861
US

IV. Provider business mailing address

381 AYLESBURY DR S
WESTERVILLE OH
43082-6346
US

V. Phone/Fax

Practice location:
  • Phone: 614-453-1065
  • Fax:
Mailing address:
  • Phone: 614-565-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61273754
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0135726
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13792-NP
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP61273754
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.13792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: