Provider Demographics
NPI:1215640487
Name:AYUKETAH, EDWIN JOSE ENOWKPEN
Entity type:Individual
Prefix:MR
First Name:EDWIN JOSE
Middle Name:ENOWKPEN
Last Name:AYUKETAH
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 1:7632 OVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9338
Mailing Address - Country:US
Mailing Address - Phone:513-882-5753
Mailing Address - Fax:513-882-5753
Practice Address - Street 1:7632 OVERGLEN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9338
Practice Address - Country:US
Practice Address - Phone:513-882-5753
Practice Address - Fax:513-772-8547
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide