Provider Demographics
NPI:1295981199
Name:AYENSU, STELLA BOATEMAH (RN)
Entity type:Individual
Prefix:MS
First Name:STELLA
Middle Name:BOATEMAH
Last Name:AYENSU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 CHEYENNE WAY
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5121
Mailing Address - Country:US
Mailing Address - Phone:614-755-9084
Mailing Address - Fax:
Practice Address - Street 1:377 CHEYENNE WAY
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5121
Practice Address - Country:US
Practice Address - Phone:614-755-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 331105163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse