Healthcare Provider Details

I. General information

NPI: 1861723827
Provider Name (Legal Business Name): THEOPHILIA OBENEWAA AKOMAH-DONKOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 BROOKVIEW PL
MASON OH
45040-1396
US

IV. Provider business mailing address

4465 BROOKVIEW PL
MASON OH
45040-1396
US

V. Phone/Fax

Practice location:
  • Phone: 614-596-4506
  • Fax:
Mailing address:
  • Phone: 614-596-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.0028057
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN351329
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: