Healthcare Provider Details

I. General information

NPI: 1275243008
Provider Name (Legal Business Name): GASMIR DARIN NJILA SEUGWOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 GOLDEN CLOUD LN
COLUMBUS OH
43228-6436
US

IV. Provider business mailing address

1640 GOLDEN CLOUD LN
COLUMBUS OH
43228-6436
US

V. Phone/Fax

Practice location:
  • Phone: 614-852-0406
  • Fax:
Mailing address:
  • Phone: 614-852-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: