Healthcare Provider Details

I. General information

NPI: 1750705737
Provider Name (Legal Business Name): KUKUA TOFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 TRAIL E
ETNA OH
43062-9690
US

IV. Provider business mailing address

258 TRAIL E
ETNA OH
43062-9690
US

V. Phone/Fax

Practice location:
  • Phone: 614-209-6927
  • Fax:
Mailing address:
  • Phone: 614-209-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN388177
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: