Provider Demographics
NPI:1427773928
Name:KARGBO, HENNIE N
Entity type:Individual
Prefix:
First Name:HENNIE
Middle Name:N
Last Name:KARGBO
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 1:962 MASTER DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8239
Mailing Address - Country:US
Mailing Address - Phone:614-556-0243
Mailing Address - Fax:
Practice Address - Street 1:962 MASTER DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8239
Practice Address - Country:US
Practice Address - Phone:614-556-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide