Provider Demographics
NPI:1114650579
Name:DORNOO, OSSIE MAE (CNP)
Entity Type:Individual
Prefix:
First Name:OSSIE
Middle Name:MAE
Last Name:DORNOO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 HUGHEY SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3692
Mailing Address - Country:US
Mailing Address - Phone:216-526-2373
Mailing Address - Fax:
Practice Address - Street 1:2100 STELLA CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1011
Practice Address - Country:US
Practice Address - Phone:614-252-8402
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351093163W00000X
APRN.CNP.0032653251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495167Medicaid