Healthcare Provider Details

I. General information

NPI: 1962243311
Provider Name (Legal Business Name): TRUPHENA JEPKOGEI KIBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CHAPEL HILL DR
FAIRFIELD OH
45014-5285
US

IV. Provider business mailing address

94 CHAPEL HILL DR
FAIRFIELD OH
45014-5285
US

V. Phone/Fax

Practice location:
  • Phone: 513-869-1832
  • Fax:
Mailing address:
  • Phone: 513-869-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberMA-C.001372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: