Provider Demographics
NPI:1396972253
Name:KOROMA, BAI (LPN)
Entity type:Individual
Prefix:
First Name:BAI
Middle Name:
Last Name:KOROMA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MALLOY LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9354
Mailing Address - Country:US
Mailing Address - Phone:614-516-7686
Mailing Address - Fax:
Practice Address - Street 1:221 MALLOY LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9354
Practice Address - Country:US
Practice Address - Phone:614-516-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN- 131850 IV164W00000X
OHPN-131850 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse