Provider Demographics
NPI:1255635439
Name:ANTWI, THERESA (LPN)
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:ANTWI
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 1:5109 WINTON RD
Mailing Address - Street 2:#D
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2985
Mailing Address - Country:US
Mailing Address - Phone:513-829-2171
Mailing Address - Fax:
Practice Address - Street 1:5109 WINTON RD
Practice Address - Street 2:#D
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2985
Practice Address - Country:US
Practice Address - Phone:513-829-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-127758164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse