Provider Demographics
NPI:1023394418
Name:WREFDIPKO, KSANGALOR BLESSING (STNA)
Entity Type:Individual
Prefix:
First Name:KSANGALOR
Middle Name:BLESSING
Last Name:WREFDIPKO
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:MILKA
Other - Middle Name:
Other - Last Name:BONYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:2784 CITIZENS PL APT G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4426
Mailing Address - Country:US
Mailing Address - Phone:614-772-5684
Mailing Address - Fax:
Practice Address - Street 1:2784 CITIZENS PL APT G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4426
Practice Address - Country:US
Practice Address - Phone:614-772-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide