Provider Demographics
NPI:1659880219
Name:KASWOSWE, EDINA
Entity Type:Individual
Prefix:
First Name:EDINA
Middle Name:
Last Name:KASWOSWE
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 1:8928 SHADY WOODS ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7973
Mailing Address - Country:US
Mailing Address - Phone:614-230-1739
Mailing Address - Fax:
Practice Address - Street 1:8928 SHADY WOODS STREET
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110
Practice Address - Country:US
Practice Address - Phone:614-230-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146393.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty