Provider Demographics
NPI:1235517293
Name:OTENG-NYARKO, FAUSTINA
Entity Type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:
Last Name:OTENG-NYARKO
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 1:850 CRAWFORD PKWY APT 4309
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2326
Mailing Address - Country:US
Mailing Address - Phone:301-500-4916
Mailing Address - Fax:
Practice Address - Street 1:850 CRAWFORD PKWY APT 4309
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2326
Practice Address - Country:US
Practice Address - Phone:301-500-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide