Individual
BAI KOROMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
221 MALLOY LN, BLACKLICK, OH 43004-9354
(614) 516-7686
Mailing address
221 MALLOY LN, BLACKLICK, OH 43004-9354
(614) 516-7686
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN- 131850 IV
OH
164W00000X
Licensed Practical Nurse
PN-131850 IV
OH
Other
Enumeration date
06/18/2009
Last updated
06/18/2009
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