Provider Demographics
NPI:1841977709
Name:KHASAWNEH, MYSA H
Entity type:Individual
Prefix:
First Name:MYSA
Middle Name:H
Last Name:KHASAWNEH
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 1:2961 SEEGER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9085
Mailing Address - Country:US
Mailing Address - Phone:161-489-7555
Mailing Address - Fax:
Practice Address - Street 1:2961 SEEGER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9085
Practice Address - Country:US
Practice Address - Phone:161-489-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health