Provider Demographics
NPI:1205509452
Name:TOH-FOMBANG, SLESSOR MAH
Entity type:Individual
Prefix:
First Name:SLESSOR
Middle Name:MAH
Last Name:TOH-FOMBANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8732 LINICK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4782
Mailing Address - Country:US
Mailing Address - Phone:614-772-4473
Mailing Address - Fax:
Practice Address - Street 1:6400 E BROAD ST STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2979
Practice Address - Country:US
Practice Address - Phone:614-655-3345
Practice Address - Fax:614-317-4689
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.456245163W00000X
OHAPRN.CNP.0030416363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse