Provider Demographics
NPI:1437438397
Name:KUKUBOR, SALIME KOKUI
Entity Type:Individual
Prefix:
First Name:SALIME
Middle Name:KOKUI
Last Name:KUKUBOR
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 1:6213 DOEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2220
Mailing Address - Country:US
Mailing Address - Phone:614-747-4529
Mailing Address - Fax:
Practice Address - Street 1:6213 DOEWOOD CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2220
Practice Address - Country:US
Practice Address - Phone:614-747-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN138905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse