Provider Demographics
NPI:1821865619
Name:OPOKU SIAW, ANTIONETTE (CNP-C)
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:OPOKU SIAW
Suffix:
Gender:F
Credentials:CNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3568
Mailing Address - Country:US
Mailing Address - Phone:614-880-9402
Mailing Address - Fax:614-880-9401
Practice Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3568
Practice Address - Country:US
Practice Address - Phone:614-880-9402
Practice Address - Fax:614-880-9401
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily