Provider Demographics
NPI:1790969830
Name:OMAMEH, NWAKEGO P (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:NWAKEGO
Middle Name:P
Last Name:OMAMEH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 SASSAFRAS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5259
Mailing Address - Country:US
Mailing Address - Phone:614-431-2594
Mailing Address - Fax:
Practice Address - Street 1:5151 SASSAFRAS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5259
Practice Address - Country:US
Practice Address - Phone:614-431-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2200611Medicaid