Provider Demographics
NPI:1114652260
Name:OWUSU, PHILOMINA BANNOR (RN)
Entity Type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:BANNOR
Last Name:OWUSU
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 1:15 C ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2109
Mailing Address - Country:US
Mailing Address - Phone:978-551-0952
Mailing Address - Fax:
Practice Address - Street 1:15 C ST
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2109
Practice Address - Country:US
Practice Address - Phone:978-551-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2299952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty