Provider Demographics
NPI:1083919344
Name:DEGOH, MAGDALINE MANYI (LPN)
Entity Type:Individual
Prefix:
First Name:MAGDALINE
Middle Name:MANYI
Last Name:DEGOH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W WENGER RD APT 217
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1922
Mailing Address - Country:US
Mailing Address - Phone:937-681-1211
Mailing Address - Fax:
Practice Address - Street 1:711 W WENGER RD APT 217
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1922
Practice Address - Country:US
Practice Address - Phone:937-681-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP40360164W00000X
OH143725164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse