Provider Demographics
NPI:1003128786
Name:SOW, ANTA FALL (CNP)
Entity type:Individual
Prefix:MS
First Name:ANTA
Middle Name:FALL
Last Name:SOW
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6631 BRICEGROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8306
Mailing Address - Country:US
Mailing Address - Phone:614-307-0368
Mailing Address - Fax:
Practice Address - Street 1:6631 BRICEGROVE BLVD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8306
Practice Address - Country:US
Practice Address - Phone:614-307-0368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2024-10-10
Deactivation Date:2022-11-18
Deactivation Code:
Reactivation Date:2024-08-15
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11568-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily