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General NPI Number Information
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NPI Number | 1760785760
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Entity Type | Individual
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Provider Name | VIDA ANITA BOAFO NP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 7161 DIXIE HWY
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City | FAIRFIELD
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State | OH
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Zip | 45014-5542
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Country | US
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Telephone | 513-737-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 7161 DIXIE HWY
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City | FAIRFIELD
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State | OH
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Zip | 45014-5542
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Country | US
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Telephone | 513-973-9240
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Fax | 513-401-9399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN352692
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA. 18424-NP
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License Number State | OH
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