Basic Information
| Provider Information | |||||||||
| NPI: | 1689336539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INYANG | ||||||||
| FirstName: | IMO | ||||||||
| MiddleName: | ENE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3808 FAIRWAY PARK DR APT 205 | ||||||||
| Address2: | |||||||||
| City: | COPLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443212973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819748216 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455042687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375231000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN.461010 | OH | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.