Provider Demographics
NPI:1104450691
Name:NNAJI, ASSUMPTA NGOZI (APRN)
Entity type:Individual
Prefix:
First Name:ASSUMPTA
Middle Name:NGOZI
Last Name:NNAJI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1256
Mailing Address - Country:US
Mailing Address - Phone:419-490-3737
Mailing Address - Fax:
Practice Address - Street 1:501 VAN BUREN ST STE 203
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1593
Practice Address - Country:US
Practice Address - Phone:419-436-6888
Practice Address - Fax:419-436-6887
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP026383363L00000X
OHRN312060163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395056Medicaid