Provider Demographics
NPI:1093081614
Name:BOSOMPEM, MARY POKUAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:POKUAH
Last Name:BOSOMPEM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:POKUAH
Other - Last Name:DONKOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:47- 07 30 PL.
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101
Mailing Address - Country:US
Mailing Address - Phone:718-472-5671
Mailing Address - Fax:718-472-9117
Practice Address - Street 1:47- 07 30 PL.
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-472-5671
Practice Address - Fax:718-472-9117
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY439762-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse