Provider Demographics
NPI:1568719938
Name:ANSAH, BERNICE (LPN)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:ANSAH
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 1:2090 CROTONA PKWY APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1696
Mailing Address - Country:US
Mailing Address - Phone:646-331-1606
Mailing Address - Fax:
Practice Address - Street 1:2090 CROTONA PKWY APT 6A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1696
Practice Address - Country:US
Practice Address - Phone:646-331-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310656-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY310656-1OtherLPN LICENSE