Provider Demographics
NPI:1205367521
Name:ACHEAMPONG, SAMUEL DOMPREH (LPN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DOMPREH
Last Name:ACHEAMPONG
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 ANDREWS AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6015
Mailing Address - Country:US
Mailing Address - Phone:347-692-5380
Mailing Address - Fax:
Practice Address - Street 1:2280 ANDREWS AVE APT 6C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6015
Practice Address - Country:US
Practice Address - Phone:347-692-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327778-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse