Stella Nnoko Mbongo Akwo Taboh
Individual provider Active NPI Registered Nurse · Groveport, OH
NPI 1104610013 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1104610013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 544152 (OH)
- Practice address
- 5209 Macclellan St S
Groveport, OH 43125-8503 - Phone
- (240) 390-7268
- NPI assigned
- Apr 7, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 544152 | OH | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 544152 | OH | Yes |
Addresses
Primary practice location
5209 Macclellan St S
Groveport, OH 43125-8503
Mailing address
5209 Macclellan St S
Groveport, OH 43125-8503
Other providers in Groveport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.