Provider Demographics
NPI:1952687154
Name:DZAKAH, FOSTER KWAME (RN)
Entity Type:Individual
Prefix:
First Name:FOSTER
Middle Name:KWAME
Last Name:DZAKAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:FOSTER
Other - Middle Name:
Other - Last Name:DZAKAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:553 WHITE CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9326
Mailing Address - Country:US
Mailing Address - Phone:614-584-1537
Mailing Address - Fax:
Practice Address - Street 1:553 WHITE CEDAR CT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9326
Practice Address - Country:US
Practice Address - Phone:614-584-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN376006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse