Provider Demographics
NPI:1043585821
Name:BISSAH, ADWOA (RN)
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:
Last Name:BISSAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLINVILLE AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5554
Mailing Address - Country:US
Mailing Address - Phone:718-708-4779
Mailing Address - Fax:718-466-4321
Practice Address - Street 1:3555 OLINVILLE AVE APT 4F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5554
Practice Address - Country:US
Practice Address - Phone:718-708-4779
Practice Address - Fax:718-466-4321
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse