Provider Demographics
NPI:1205362951
Name:OBENG-ASARE, OLIVIA ASANTEWAA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ASANTEWAA
Last Name:OBENG-ASARE
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 1:275 MODER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1540
Mailing Address - Country:US
Mailing Address - Phone:513-356-3382
Mailing Address - Fax:
Practice Address - Street 1:275 MODER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1540
Practice Address - Country:US
Practice Address - Phone:513-356-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.449884163WP0808X
OH164785.MEDS-IV164W00000X
OHAPRN.CNP.0035954363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230255Medicaid