Provider Demographics
NPI:1508007543
Name:AKAMA-DIBO, CATHERINE KONGE
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:KONGE
Last Name:AKAMA-DIBO
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 1:12171 HUNTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1242
Mailing Address - Country:US
Mailing Address - Phone:513-851-7169
Mailing Address - Fax:
Practice Address - Street 1:12171 HUNTERGREEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1242
Practice Address - Country:US
Practice Address - Phone:513-851-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130676164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse