Provider Demographics
NPI:1225860398
Name:ABODE, ENAGNON TATIANA PRISCA
Entity type:Individual
Prefix:
First Name:ENAGNON
Middle Name:TATIANA PRISCA
Last Name:ABODE
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 1:7228 MCQUEEN DR NW
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-3229
Mailing Address - Country:US
Mailing Address - Phone:518-776-9940
Mailing Address - Fax:
Practice Address - Street 1:7228 MCQUEEN DR NW
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-3229
Practice Address - Country:US
Practice Address - Phone:518-776-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant