MEDICARE: CHERNOR AMADU BAH NURSE

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	164W00000X	Licensed Practical Nurse	PN.151958-M-IV	OH

General Provider Information

NPI Number	:	1366781809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERNOR AMADU BAH NURSE

Provider Business Mailing Address
First Line	:	1393 GREENCROFT RD.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-7096
Country	:	US
Telephone Number	:	614-323-7717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1393 GREENCROFT RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-1781
Country	:	US
Telephone Number	:	614-323-7717
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	03/28/2016

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