Healthcare Provider Details

I. General information

NPI: 1265640718
Provider Name (Legal Business Name): PAUL NTOH WALLANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 DENISE DR
COLUMBUS OH
43229-5301
US

IV. Provider business mailing address

1869 DENISE DR
COLUMBUS OH
43229-5301
US

V. Phone/Fax

Practice location:
  • Phone: 614-515-7507
  • Fax:
Mailing address:
  • Phone: 614-515-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number139344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: