Provider Demographics
NPI:1033572490
Name:AMOAH, ERNESTINA M (FNP)
Entity Type:Individual
Prefix:
First Name:ERNESTINA
Middle Name:M
Last Name:AMOAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1604
Mailing Address - Country:US
Mailing Address - Phone:201-439-1118
Mailing Address - Fax:
Practice Address - Street 1:30 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1604
Practice Address - Country:US
Practice Address - Phone:201-439-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00421900363LF0000X
NYF337939-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily