Provider Demographics
NPI:1205609898
Name:KOFFI, EMMA GOME (LPN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GOME
Last Name:KOFFI
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 1:80 MARTINI CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1282
Mailing Address - Country:US
Mailing Address - Phone:151-354-0916
Mailing Address - Fax:
Practice Address - Street 1:80 MARTINI CT
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1282
Practice Address - Country:US
Practice Address - Phone:151-354-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185455164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse