Healthcare Provider Details

I. General information

NPI: 1447197116
Provider Name (Legal Business Name): MYRICE NOELLE KAMWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRICE NOELLE MBAZOO-ETO NP

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9944 SCOTCH PINE DR
SPRINGBORO OH
45066-5236
US

IV. Provider business mailing address

9944 SCOTCH PINE DR
SPRINGBORO OH
45066-5236
US

V. Phone/Fax

Practice location:
  • Phone: 614-214-7928
  • Fax:
Mailing address:
  • Phone: 614-214-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: