Provider Demographics
NPI:1134438211
Name:AGYEMANG, PATIENCE BENISA (LPN)
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:BENISA
Last Name:AGYEMANG
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 1:11780 CHANTICLEER DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7810
Mailing Address - Country:US
Mailing Address - Phone:614-920-0499
Mailing Address - Fax:
Practice Address - Street 1:11780 CHANTICLEER DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7810
Practice Address - Country:US
Practice Address - Phone:614-920-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse