Provider Demographics
NPI:1346645983
Name:ACHAMPONG, ADWOA
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:
Last Name:ACHAMPONG
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 1:2475 TRATMAN AVENUE
Mailing Address - Street 2:3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:347-797-7544
Mailing Address - Fax:
Practice Address - Street 1:2475 TRATMAN AVE
Practice Address - Street 2:3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3405
Practice Address - Country:US
Practice Address - Phone:347-797-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293889-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse