Provider Demographics
NPI:1003100215
Name:ASAMOAH, ANITA (LPN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ASAMOAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 FENTON AVE
Mailing Address - Street 2:APT-1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2024
Mailing Address - Country:US
Mailing Address - Phone:646-359-9538
Mailing Address - Fax:
Practice Address - Street 1:3458 FENTON AVE
Practice Address - Street 2:APT-1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2024
Practice Address - Country:US
Practice Address - Phone:646-359-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299544164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse