Provider Demographics
NPI:1003676966
Name:POKUAA, WINIFRED
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:
Last Name:POKUAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9352 HERRINGBONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1842
Mailing Address - Country:US
Mailing Address - Phone:701-590-8632
Mailing Address - Fax:
Practice Address - Street 1:9352 HERRINGBONE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-1842
Practice Address - Country:US
Practice Address - Phone:701-590-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility