Provider Demographics
NPI:1538640420
Name:AMPOFO, ISAAC OKYERE
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:OKYERE
Last Name:AMPOFO
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 1:629 MIDDLE TURNPIKE EAST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3731
Mailing Address - Country:US
Mailing Address - Phone:860-649-6900
Mailing Address - Fax:860-647-0469
Practice Address - Street 1:629 MIDDLE TURNPIKE EAST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3571
Practice Address - Country:US
Practice Address - Phone:860-649-6900
Practice Address - Fax:860-647-0469
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTF08180668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF08180668OtherAANP