Provider Demographics
NPI:1740437409
Name:BAH, ALPHA IBRAHIM (LPN)
Entity type:Individual
Prefix:
First Name:ALPHA
Middle Name:IBRAHIM
Last Name:BAH
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 1:4420 BIG WALNUTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4143
Mailing Address - Country:US
Mailing Address - Phone:614-506-4701
Mailing Address - Fax:
Practice Address - Street 1:4420 BIG WALNUTVIEW DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4143
Practice Address - Country:US
Practice Address - Phone:614-506-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118660164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse