Provider Demographics
NPI:1376324954
Name:KANNEH, ABU-BAKARR
Entity Type:Individual
Prefix:MR
First Name:ABU-BAKARR
Middle Name:
Last Name:KANNEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5981 WYNNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3587
Mailing Address - Country:US
Mailing Address - Phone:617-372-4418
Mailing Address - Fax:
Practice Address - Street 1:5981 WYNNEWOOD DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3587
Practice Address - Country:US
Practice Address - Phone:617-372-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.175196.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse