Provider Demographics
NPI:1598025090
Name:BOATENG, LUCY YAWOVI
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:YAWOVI
Last Name:BOATENG
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 1:3421 TOLEDO TER
Mailing Address - Street 2:APT M
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1958
Mailing Address - Country:US
Mailing Address - Phone:301-559-5622
Mailing Address - Fax:
Practice Address - Street 1:3421 TOLEDO TER
Practice Address - Street 2:APT M
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1958
Practice Address - Country:US
Practice Address - Phone:301-559-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB-352-560-946-962374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide