Provider Demographics
NPI:1194065417
Name:MKANGARA, OMMARI BAALIY (LPN)
Entity type:Individual
Prefix:
First Name:OMMARI
Middle Name:BAALIY
Last Name:MKANGARA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:DR
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6543 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9393
Mailing Address - Country:US
Mailing Address - Phone:614-887-8287
Mailing Address - Fax:
Practice Address - Street 1:6543 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9393
Practice Address - Country:US
Practice Address - Phone:614-887-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 135852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse