Provider Demographics
NPI:1598229338
Name:ODOOM AMOAH, JEMIMA
Entity Type:Individual
Prefix:MS
First Name:JEMIMA
Middle Name:
Last Name:ODOOM AMOAH
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 1:1048 COLD WATER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-2550
Mailing Address - Country:US
Mailing Address - Phone:513-598-0440
Mailing Address - Fax:
Practice Address - Street 1:1048 COLD WATER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-2550
Practice Address - Country:US
Practice Address - Phone:513-598-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse