Provider Demographics
NPI:1194357285
Name:BOAMAH, ADWOA BOAMAH
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:BOAMAH
Last Name:BOAMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 ELDERT LN APT 12E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4248
Mailing Address - Country:US
Mailing Address - Phone:347-654-5766
Mailing Address - Fax:
Practice Address - Street 1:760 ELDERT LN APT 12E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4248
Practice Address - Country:US
Practice Address - Phone:347-654-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse