Provider Demographics
NPI:1275650178
Name:KOKENGE, MARY ANN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:KOKENGE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE.
Mailing Address - Street 2:ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-0356
Mailing Address - Fax:513-636-9286
Practice Address - Street 1:3333 BURNET AVE.
Practice Address - Street 2:ML 4000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4681
Practice Address - Fax:513-636-8844
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-03210-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily