Provider Demographics
NPI:1477905461
Name:KOROMA, JANE (MSN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KOROMA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N WILSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1214
Mailing Address - Country:US
Mailing Address - Phone:614-702-7915
Mailing Address - Fax:614-965-6534
Practice Address - Street 1:50 N WILSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1214
Practice Address - Country:US
Practice Address - Phone:614-702-7915
Practice Address - Fax:614-965-6534
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026464363LF0000X
OHRN.389299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201915Medicaid