Healthcare Provider Details

I. General information

NPI: 1427717289
Provider Name (Legal Business Name): PROMISE ALLO TAMBONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 CITYGATE DR
COLUMBUS OH
43219-3656
US

IV. Provider business mailing address

3142 ALDERBROOK DR
PICKERINGTON OH
43147-9085
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: