Provider Demographics
NPI:1598027542
Name:ACHEAMPONG, MABEL
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:ACHEAMPONG
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 1:2175 RYER AVE
Mailing Address - Street 2:APT 4G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2127
Mailing Address - Country:US
Mailing Address - Phone:973-868-7895
Mailing Address - Fax:
Practice Address - Street 1:2175 RYER AVE
Practice Address - Street 2:APT 4G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2127
Practice Address - Country:US
Practice Address - Phone:973-868-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309783164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse