Healthcare Provider Details

I. General information

NPI: 1629942487
Provider Name (Legal Business Name): ABENA BIRAGO BOGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WITTENBERG DR
FAIRFIELD OH
45014-2930
US

IV. Provider business mailing address

910 WITTENBERG DR
FAIRFIELD OH
45014-2930
US

V. Phone/Fax

Practice location:
  • Phone: 513-446-7555
  • Fax:
Mailing address:
  • Phone: 513-446-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4307HHN
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number4406HHS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: