Basic Information
| Provider Information | |||||||||
| NPI: | 1225642861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUFUOH | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | ASENSO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 E DUBLIN GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1855 E DUBLIN GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2020 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.