Provider Demographics
NPI:1629461447
Name:TAKU, EMILIAN
Entity Type:Individual
Prefix:
First Name:EMILIAN
Middle Name:
Last Name:TAKU
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 1:4187 HELENROSE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4059
Mailing Address - Country:US
Mailing Address - Phone:614-312-2117
Mailing Address - Fax:
Practice Address - Street 1:4187 HELENROSE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4059
Practice Address - Country:US
Practice Address - Phone:614-312-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse