Provider Demographics
NPI:1922340983
Name:BOATENG, MARTINA AGYENIM (LPN)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:AGYENIM
Last Name:BOATENG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 MOUNT BADON
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8297
Mailing Address - Country:US
Mailing Address - Phone:614-805-6199
Mailing Address - Fax:
Practice Address - Street 1:6416 MOUNT BADON
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8297
Practice Address - Country:US
Practice Address - Phone:614-805-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151430164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse