Provider Demographics
NPI:1548978372
Name:AMAAZEE, ELIZABETH KUMBONG
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KUMBONG
Last Name:AMAAZEE
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 1:88 RIDGE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-6112
Mailing Address - Country:US
Mailing Address - Phone:513-612-0582
Mailing Address - Fax:
Practice Address - Street 1:88 RIDGE DR APT 204
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-6112
Practice Address - Country:US
Practice Address - Phone:513-612-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH77274123Medicaid