Provider Demographics
NPI:1679178321
Name:NDA-ACKAH, ETHELEN V (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ETHELEN
Middle Name:V
Last Name:NDA-ACKAH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 TAMARACK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5241
Mailing Address - Country:US
Mailing Address - Phone:614-937-3276
Mailing Address - Fax:
Practice Address - Street 1:4960 TAMARACK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5241
Practice Address - Country:US
Practice Address - Phone:614-937-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily