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General NPI Number Information
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NPI Number | 1669882601
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Entity Type | Organization
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Legal Business Name | EDIYE ENOOBONG
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 4672 HARBINGER CIR W
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City | WHITEHALL
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State | OH
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Zip | 43213-6115
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Country | US
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Telephone | 614-377-9044
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Fax | 614-453-5712
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Provider Business Mailing Address
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Address Line | 4672 HARBINGER CIR W
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City | WHITEHALL
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State | OH
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Zip | 43213-6115
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Country | US
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Telephone | 614-377-9044
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Fax | 614-453-5712
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | EDIYE JOY ENOOBONG
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Credential | NURSE
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Telephone | 614-377-9044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 156004
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License Number State | OH
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