Provider Demographics
NPI:1508069519
Name:MORFAW, NICHOLAS AGEBOH (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AGEBOH
Last Name:MORFAW
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARKLAWN BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3811
Mailing Address - Country:US
Mailing Address - Phone:614-622-6115
Mailing Address - Fax:
Practice Address - Street 1:200 PARKLAWN BLVD APT E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3811
Practice Address - Country:US
Practice Address - Phone:614-622-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN . 123037376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator