Provider Demographics
NPI:1275164048
Name:ENOW, FRIDA TARH
Entity Type:Individual
Prefix:
First Name:FRIDA
Middle Name:TARH
Last Name:ENOW
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 1:4135 LITTLE PINE DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1167
Mailing Address - Country:US
Mailing Address - Phone:734-890-6307
Mailing Address - Fax:
Practice Address - Street 1:4135 LITTLE PINE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1167
Practice Address - Country:US
Practice Address - Phone:734-890-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse