Provider Demographics
NPI:1073890117
Name:ASIEDU-OFEI, CONSTANCE ABIGAIL (MD)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ABIGAIL
Last Name:ASIEDU-OFEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:336 CHARDONNAY AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-786-2002
Practice Address - Fax:509-786-2026
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058378208000000X
WAMD60636546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073890117Medicaid