Provider Demographics
NPI:1700475373
Name:NKANSA, KWADWO BOSOMPRAH
Entity Type:Individual
Prefix:
First Name:KWADWO
Middle Name:BOSOMPRAH
Last Name:NKANSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 AMBARWENT RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7055
Mailing Address - Country:US
Mailing Address - Phone:614-537-7678
Mailing Address - Fax:
Practice Address - Street 1:3122 AMBARWENT RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7055
Practice Address - Country:US
Practice Address - Phone:614-537-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse