Provider Demographics
NPI:1417222480
Name:ADJEI, ANNIE BRUNGER
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:BRUNGER
Last Name:ADJEI
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 1:6215 NORTHGATE RD
Mailing Address - Street 2:APARTMENT P
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2457
Mailing Address - Country:US
Mailing Address - Phone:614-432-0358
Mailing Address - Fax:
Practice Address - Street 1:6215 NORTHGATE RD
Practice Address - Street 2:APARTMENT P
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2457
Practice Address - Country:US
Practice Address - Phone:614-432-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.161465-M-IV164W00000X
OH401237500511376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse