Provider Demographics
NPI:1174297915
Name:BOACHIE-ANSAH, ANTOINETTE (NP)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:BOACHIE-ANSAH
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 1:100 DE KRUIF PL APT 19L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2463
Mailing Address - Country:US
Mailing Address - Phone:347-277-1683
Mailing Address - Fax:
Practice Address - Street 1:100 DE KRUIF PL APT 19L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2463
Practice Address - Country:US
Practice Address - Phone:347-277-1683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily