Basic Information
| Provider Information | |||||||||
| NPI: | 1477905461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOROMA | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N WILSON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432041214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147027915 | ||||||||
| FaxNumber: | 6149656534 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N WILSON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432041214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147027915 | ||||||||
| FaxNumber: | 6149656534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.026464 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | RN.389299 | OH | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 0201915 | 05 | OH | MEDICAID |