Provider Demographics
NPI:1992375943
Name:KORANTENG, ANGELA OBO (RN,BSN,ADHS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:OBO
Last Name:KORANTENG
Suffix:
Gender:F
Credentials:RN,BSN,ADHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 DILEY RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9939
Mailing Address - Country:US
Mailing Address - Phone:614-751-6413
Mailing Address - Fax:
Practice Address - Street 1:603 DILEY RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9939
Practice Address - Country:US
Practice Address - Phone:614-751-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.401690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364SL0600XMedicaid