Provider Demographics
NPI:1710540356
Name:ASANA NAWAH, IDRISU
Entity Type:Individual
Prefix:
First Name:IDRISU
Middle Name:
Last Name:ASANA NAWAH
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 1:445 DEWDROP CIR APT A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3726
Mailing Address - Country:US
Mailing Address - Phone:573-586-9954
Mailing Address - Fax:
Practice Address - Street 1:445 DEWDROP CIR APT A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3726
Practice Address - Country:US
Practice Address - Phone:573-586-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty