Provider Demographics
NPI:1548532922
Name:AIGBEVBOILE, BEN O (STNA)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:O
Last Name:AIGBEVBOILE
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 ATSON LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-2901
Mailing Address - Country:US
Mailing Address - Phone:513-591-8258
Mailing Address - Fax:
Practice Address - Street 1:1688 ATSON LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-2901
Practice Address - Country:US
Practice Address - Phone:513-591-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400759360508376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide