Provider Demographics
NPI:1215487400
Name:AGYEMANG-BOTCHWAY, ERNEST NANA
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:NANA
Last Name:AGYEMANG-BOTCHWAY
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 1:87 VERSAILLES
Mailing Address - Street 2:11100 SPINGFIELD PIKE,CINCINNATI,OHIO 45246
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3826
Mailing Address - Country:US
Mailing Address - Phone:513-307-8898
Mailing Address - Fax:
Practice Address - Street 1:87 VERSAILLES
Practice Address - Street 2:87 VERSAILLES
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3826
Practice Address - Country:US
Practice Address - Phone:513-307-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160610164W00000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376G00000XNursing Service Related ProvidersNursing Home Administrator