Provider Demographics
NPI:1760785760
Name:BOAFO, VIDA ANITA (NP)
Entity Type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:ANITA
Last Name:BOAFO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9049
Mailing Address - Country:US
Mailing Address - Phone:513-973-9240
Mailing Address - Fax:513-401-9399
Practice Address - Street 1:230 NORTHLAND BLVD
Practice Address - Street 2:STE 213
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3752
Practice Address - Country:US
Practice Address - Phone:513-737-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN352692163W00000X
OHCOA. 18424-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse