Provider Demographics
NPI:1487963807
Name:OPPONG, MARK KWAME (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:KWAME
Last Name:OPPONG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MACENROE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9339
Mailing Address - Country:US
Mailing Address - Phone:614-256-9209
Mailing Address - Fax:614-577-0767
Practice Address - Street 1:167 MACENROE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9339
Practice Address - Country:US
Practice Address - Phone:614-256-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-359435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse