Provider Demographics
NPI:1265781512
Name:NKANSAH-WIAFE, MARY (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:NKANSAH-WIAFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 AYLESBURY DR S
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6346
Mailing Address - Country:US
Mailing Address - Phone:614-565-1414
Mailing Address - Fax:
Practice Address - Street 1:112 JEFFERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1861
Practice Address - Country:US
Practice Address - Phone:614-453-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIAP61273754363LA2200X
VT101.0135726363LA2200X
OHCOA.13792-NP363LF0000X
WAAP61273754363LP2300X
OHAPRN.CNP.13792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care