Provider Demographics
NPI:1306122411
Name:BOATEMAA, MARY ADU
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ADU
Last Name:BOATEMAA
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 1:5666 KINGSHIP LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3009
Mailing Address - Country:US
Mailing Address - Phone:614-599-0564
Mailing Address - Fax:
Practice Address - Street 1:1430 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1045
Practice Address - Country:US
Practice Address - Phone:614-599-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.436394163W00000X
OHAPRN.CNP.0038309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse