Provider Demographics
NPI:1003557976
Name:KANKAM, ERNEST BOADU
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:BOADU
Last Name:KANKAM
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 1:1983 SEDGWICK AVE APT GD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-2717
Mailing Address - Country:US
Mailing Address - Phone:347-340-9327
Mailing Address - Fax:
Practice Address - Street 1:1983 SEDGWICK AVE APT GD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-2717
Practice Address - Country:US
Practice Address - Phone:347-340-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY761422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse