Provider Demographics
NPI:1033740824
Name:BOATENG, SAMUEL AGYENIM (CNP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:AGYENIM
Last Name:BOATENG
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:144 BRANDYWINE DR APT B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1379
Mailing Address - Country:US
Mailing Address - Phone:614-806-8865
Mailing Address - Fax:
Practice Address - Street 1:HOLY HILLS HEALTHCARE SERVICES, LLC
Practice Address - Street 2:6760 TUSSING ROAD SUITE 104
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4136
Practice Address - Country:US
Practice Address - Phone:614-626-6000
Practice Address - Fax:614-577-0807
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily