Provider Demographics
NPI:1477877645
Name:AGGOE-OPOKU, MABEL
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:AGGOE-OPOKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MABEL
Other - Middle Name:
Other - Last Name:AGGOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:3955 SNOWSHOE AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1198
Mailing Address - Country:US
Mailing Address - Phone:614-209-9340
Mailing Address - Fax:
Practice Address - Street 1:4191 KELNOR DR STE 300
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3990
Practice Address - Country:US
Practice Address - Phone:614-875-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022236363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily