Provider Demographics
NPI:1962712414
Name:OWUSU, IRENE (STNA)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:OWUSU
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3598 CARTHAGE CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3916
Mailing Address - Country:US
Mailing Address - Phone:614-776-1299
Mailing Address - Fax:
Practice Address - Street 1:3598 CARTHAGE CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3916
Practice Address - Country:US
Practice Address - Phone:614-776-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651577374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide