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General NPI Number Information
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NPI Number | 1871855304
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Entity Type | Organization
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Legal Business Name | MARIAMA MUSTAPHA
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 1580 WORTHINGTON CLUB DR
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City | WESTERVILLE
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State | OH
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Zip | 43081-4621
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Country | US
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Telephone | 732-213-5974
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 WORTHINGTON CLUB DR
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City | WESTERVILLE
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State | OH
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Zip | 43081-4621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MARIAMA MUSTAPHA
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Credential | NURSE
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Telephone | 732-213-5974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 128971
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License Number State | OH
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