Provider Demographics
NPI:1093311128
Name:ADDO, ADWOA (APRN)
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:
Last Name:ADDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 SUGAR MAPLE RUN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5957
Mailing Address - Country:US
Mailing Address - Phone:513-307-6596
Mailing Address - Fax:
Practice Address - Street 1:4700 ASHWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2424
Practice Address - Country:US
Practice Address - Phone:800-989-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0028089OtherOHIO BOARD OF NURSING