Healthcare Provider Details

I. General information

NPI: 1760785760
Provider Name (Legal Business Name): VIDA ANITA BOAFO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7161 DIXIE HWY
FAIRFIELD OH
45014-5542
US

IV. Provider business mailing address

7161 DIXIE HWY
FAIRFIELD OH
45014-5542
US

V. Phone/Fax

Practice location:
  • Phone: 513-737-1691
  • Fax:
Mailing address:
  • Phone: 513-973-9240
  • Fax: 513-401-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 18424-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN352692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: