Provider Demographics
NPI:1275145294
Name:NTCHOMOHO, KEVIN (LPN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NTCHOMOHO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-8443
Mailing Address - Country:US
Mailing Address - Phone:440-650-9301
Mailing Address - Fax:
Practice Address - Street 1:1481 LEISURE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-8443
Practice Address - Country:US
Practice Address - Phone:440-440-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse