Provider Demographics
NPI:1851157143
Name:FORDJOUR, PATIENCE AGYEIWAA
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:AGYEIWAA
Last Name:FORDJOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATIENCE
Other - Middle Name:FORDJOUR
Other - Last Name:FORDJOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1382 SHARON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-9016
Mailing Address - Country:US
Mailing Address - Phone:614-779-3284
Mailing Address - Fax:
Practice Address - Street 1:1382 SHARON GREEN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-9016
Practice Address - Country:US
Practice Address - Phone:614-779-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH252795343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)