Provider Demographics
NPI:1336650514
Name:TENGBEH, WOKIE
Entity Type:Individual
Prefix:
First Name:WOKIE
Middle Name:
Last Name:TENGBEH
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 1:3075 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8806
Mailing Address - Country:US
Mailing Address - Phone:614-354-4136
Mailing Address - Fax:614-340-3096
Practice Address - Street 1:3075 OMEGA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-8806
Practice Address - Country:US
Practice Address - Phone:614-354-4136
Practice Address - Fax:614-340-3096
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2311028Medicaid