Provider Demographics
NPI:1942639653
Name:AMANNFO, OFORI
Entity type:Individual
Prefix:
First Name:OFORI
Middle Name:
Last Name:AMANNFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 CAMELOT DR
Mailing Address - Street 2:5272 CAMELOT DR
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4009
Mailing Address - Country:US
Mailing Address - Phone:513-829-4816
Mailing Address - Fax:
Practice Address - Street 1:5272 CAMELOT DR
Practice Address - Street 2:5272 CAMELOT DR
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4009
Practice Address - Country:US
Practice Address - Phone:513-829-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN139761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse