Provider Demographics
NPI:1609435551
Name:ABAKPORO, AKOLAM C (RN)
Entity Type:Individual
Prefix:MRS
First Name:AKOLAM
Middle Name:C
Last Name:ABAKPORO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 IDLE HOUR CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3316
Mailing Address - Country:US
Mailing Address - Phone:717-495-0274
Mailing Address - Fax:
Practice Address - Street 1:4150 IDLE HOUR CIR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3316
Practice Address - Country:US
Practice Address - Phone:717-495-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH413660163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management