Provider Demographics
NPI:1063865806
Name:OPOKU-MENSAH, GRACE (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:OPOKU-MENSAH
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 1:4180 HUTCHINSON RIVER PKWY E
Mailing Address - Street 2:#8J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4802
Mailing Address - Country:US
Mailing Address - Phone:917-214-4284
Mailing Address - Fax:
Practice Address - Street 1:4180 HUTCHINSON RIVER PKWY E
Practice Address - Street 2:#8J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4802
Practice Address - Country:US
Practice Address - Phone:917-214-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY710366163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice