Provider Demographics
NPI:1992058598
Name:TAKEM, ANNA NDEP
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:NDEP
Last Name:TAKEM
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 1:11260 LEANDER CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240
Mailing Address - Country:US
Mailing Address - Phone:513-293-1293
Mailing Address - Fax:
Practice Address - Street 1:11260 LEANDER CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240
Practice Address - Country:US
Practice Address - Phone:513-293-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN134221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse