Provider Demographics
NPI:1629324553
Name:ASAMOAH, MAVIS
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:ASAMOAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:
Other - Last Name:ASAMOAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAVIS ASIAW
Mailing Address - Street 1:5401 COUNTRY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8975
Mailing Address - Country:US
Mailing Address - Phone:614-218-7034
Mailing Address - Fax:
Practice Address - Street 1:5401 COUNTRY MEADOW CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-218-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 149512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse