Provider Demographics
NPI:1053192153
Name:AKWANGHA, TERENCE
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:AKWANGHA
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 1:585 PRESTON TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2106
Mailing Address - Country:US
Mailing Address - Phone:614-369-6193
Mailing Address - Fax:
Practice Address - Street 1:585 PRESTON TRAILS DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2106
Practice Address - Country:US
Practice Address - Phone:614-369-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165846.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty