Provider Demographics
NPI:1376856112
Name:AMPOFO, EWURAMA AFADZIWA (APRN,NP-C)
Entity Type:Individual
Prefix:MRS
First Name:EWURAMA
Middle Name:AFADZIWA
Last Name:AMPOFO
Suffix:
Gender:F
Credentials:APRN,NP-C
Other - Prefix:
Other - First Name:EWURAMA
Other - Middle Name:AFADZIWA
Other - Last Name:HAYFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:137 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5839
Mailing Address - Country:US
Mailing Address - Phone:860-712-5956
Mailing Address - Fax:860-969-0829
Practice Address - Street 1:94 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3131
Practice Address - Country:US
Practice Address - Phone:860-712-5956
Practice Address - Fax:860-969-0829
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004400363LP2300X
CT12.004400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care