Provider Demographics
NPI:1356078679
Name:GYAMFI, SUSANA
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:GYAMFI
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 1:6215 NORTHGATE RD APT L
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2419
Mailing Address - Country:US
Mailing Address - Phone:614-973-0413
Mailing Address - Fax:
Practice Address - Street 1:6215 NORTHGATE RD APT L
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2419
Practice Address - Country:US
Practice Address - Phone:614-973-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180511164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse