Provider Demographics
NPI:1760656144
Name:TANDOH, ISAAC YAW
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:YAW
Last Name:TANDOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 TAMARACK CIR N APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4518
Mailing Address - Country:US
Mailing Address - Phone:614-432-4662
Mailing Address - Fax:
Practice Address - Street 1:1902 TAMARACK CIR N APT D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4518
Practice Address - Country:US
Practice Address - Phone:614-432-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 128629164W00000X
OH128629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse