Provider Demographics
NPI:1164281408
Name:NKEMASONG, JUSTINE NKENGMUO
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:NKENGMUO
Last Name:NKEMASONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 WOODY CT
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9645
Mailing Address - Country:US
Mailing Address - Phone:614-363-8409
Mailing Address - Fax:
Practice Address - Street 1:6943 WOODY CT
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9645
Practice Address - Country:US
Practice Address - Phone:614-363-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist