Provider Demographics
NPI:1194503342
Name:ASSANDOH, ABA
Entity type:Individual
Prefix:
First Name:ABA
Middle Name:
Last Name:ASSANDOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 ALTA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4881
Mailing Address - Country:US
Mailing Address - Phone:614-598-2524
Mailing Address - Fax:
Practice Address - Street 1:622 ALTA VIEW CT
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4881
Practice Address - Country:US
Practice Address - Phone:614-598-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker