MEDICARE: JOSEPHINE BOADI AGYAPONG FNP

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	363LF0000X	Family Nurse Practitioner	NP 16073	OH

General Provider Information

NPI Number	:	1104208347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE BOADI AGYAPONG FNP

Provider Business Mailing Address
First Line	:	3030 COOPER BLUFF DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2959
Country	:	US
Telephone Number	:	614-815-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 COOPER BLUFF DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2959
Country	:	US
Telephone Number	:	614-815-9047
Fax Number	:

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

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	06/24/2015

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