MEDICARE: IRENE KONADU YIADOM

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	163W00000X	Registered Nurse	RN.480665	OH

General Provider Information

NPI Number	:	1912504614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE KONADU YIADOM

Provider Business Mailing Address
First Line	:	4580 KIBBEY LN
Second Line	:
City	:	SOUTH LEBANON
State	:	OH
Zip	:	45065-1043
Country	:	US
Telephone Number	:	513-546-8320
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 KIBBEY LN
Second Line	:
City	:	SOUTH LEBANON
State	:	OH
Zip	:	45065-1043
Country	:	US
Telephone Number	:	513-546-8320
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “ IRENE KONADU YIADOM ” Practice Location

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