MEDICARE: NANA SERWAA AMPEM PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0039919	OH

General Provider Information

NPI Number	:	1083597454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANA SERWAA AMPEM PMHNP

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	5132 GRIFFIS LAKE DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-5919
Country	:	US
Telephone Number	:	513-307-4810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	09/02/2025

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