Primo S Ekanewang

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN 138547-MEDS Issued in OH

Practice address

3098 Arborsye CT
Reynoldsburg, OH 43068

Phone

(614) 678-9720

NPI assigned

Jan 28, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266278400000",
    "number": "1679804801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3098 ARBORSYE CT",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430689102",
            "telephone_number": "614-678-9720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3098 ARBORSYE CT",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "43068",
            "telephone_number": "614-678-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKANEWANG",
        "first_name": "PRIMO",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-28",
        "last_updated": "2010-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN 138547-MEDS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Reynoldsburg, OH
• Providers in Reynoldsburg, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.