Provider Demographics
NPI:1447842653
Name:AYITSEWOU, KOFFI MENSAH (LPN)
Entity type:Individual
Prefix:
First Name:KOFFI
Middle Name:MENSAH
Last Name:AYITSEWOU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 THOMASVILLE CT APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3046
Mailing Address - Country:US
Mailing Address - Phone:404-369-9793
Mailing Address - Fax:
Practice Address - Street 1:2655 THOMASVILLE CT APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3046
Practice Address - Country:US
Practice Address - Phone:404-369-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN177355164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse