Provider Demographics
NPI:1376299933
Name:OFORI DANSO, EMMANUEL BENTIL
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:BENTIL
Last Name:OFORI DANSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 N ORCHARD ST APT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5491
Mailing Address - Country:US
Mailing Address - Phone:773-759-7390
Mailing Address - Fax:
Practice Address - Street 1:1603 N ORCHARD ST APT 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5491
Practice Address - Country:US
Practice Address - Phone:773-759-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health