Provider Demographics
NPI:1528586427
Name:ACKAH, NANA AMA (LPN)
Entity Type:Individual
Prefix:
First Name:NANA
Middle Name:AMA
Last Name:ACKAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MILDRED ELLEY
Mailing Address - Street 2:25 BROADWAY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004
Mailing Address - Country:US
Mailing Address - Phone:212-380-9004
Mailing Address - Fax:212-232-0372
Practice Address - Street 1:25 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1010
Practice Address - Country:US
Practice Address - Phone:212-380-9004
Practice Address - Fax:212-232-0372
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328493-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse