Healthcare Provider Details

I. General information

NPI: 1346520319
Provider Name (Legal Business Name): SUSAN N. NJONJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LINCOLNSHIRE RD
GAHANNA OH
43230-2319
US

IV. Provider business mailing address

108 LINCOLNSHIRE RD
GAHANNA OH
43230-2319
US

V. Phone/Fax

Practice location:
  • Phone: 614-256-1549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number144015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: