Provider Demographics
NPI:1710719620
Name:NDEFRU, CHOH TITUS
Entity type:Individual
Prefix:
First Name:CHOH
Middle Name:TITUS
Last Name:NDEFRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SHADY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCIAL POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43116-6515
Mailing Address - Country:US
Mailing Address - Phone:614-670-2324
Mailing Address - Fax:
Practice Address - Street 1:285 SHADY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:COMMERCIAL PT
Practice Address - State:OH
Practice Address - Zip Code:43116-6515
Practice Address - Country:US
Practice Address - Phone:614-670-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH376K00000X376K00000X
OH376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide