Provider Demographics
NPI:1477188167
Name:YEBOAH, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:YEBOAH
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 1:1191 CLAY AVE APT BB
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4230
Mailing Address - Country:US
Mailing Address - Phone:917-790-9134
Mailing Address - Fax:
Practice Address - Street 1:1191 CLAY AVE APT BB
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4230
Practice Address - Country:US
Practice Address - Phone:917-790-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner