Provider Demographics
NPI:1609115740
Name:BAISEL, NANA KWESI BOTCHWAY
Entity Type:Individual
Prefix:MR
First Name:NANA KWESI
Middle Name:BOTCHWAY
Last Name:BAISEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ATWOOD TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1102
Mailing Address - Country:US
Mailing Address - Phone:614-218-7509
Mailing Address - Fax:
Practice Address - Street 1:2520 ATWOOD TER
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1102
Practice Address - Country:US
Practice Address - Phone:614-218-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110311Medicaid