Provider Demographics
NPI:1063019925
Name:OWUSU KWARTENG, NAA DEDE (NP)
Entity Type:Individual
Prefix:
First Name:NAA
Middle Name:DEDE
Last Name:OWUSU KWARTENG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 HEATHER GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4296
Mailing Address - Country:US
Mailing Address - Phone:571-354-9433
Mailing Address - Fax:
Practice Address - Street 1:10702 HEATHER GLEN WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4296
Practice Address - Country:US
Practice Address - Phone:571-354-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner