Provider Demographics
NPI:1043450638
Name:YEBOAH, AGNES
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:YEBOAH
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 1:80 MCCLELLAN ST
Mailing Address - Street 2:APT 4-P
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8641
Mailing Address - Country:US
Mailing Address - Phone:646-327-1618
Mailing Address - Fax:
Practice Address - Street 1:80 MCCLELLAN ST
Practice Address - Street 2:APT 4-P
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8641
Practice Address - Country:US
Practice Address - Phone:646-327-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607355163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse