Provider Demographics
NPI:1609632769
Name:BOATENG, DAVID KWADWO (RN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KWADWO
Last Name:BOATENG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 207TH ST W
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8821
Mailing Address - Country:US
Mailing Address - Phone:612-483-9294
Mailing Address - Fax:
Practice Address - Street 1:4413 207TH ST W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8821
Practice Address - Country:US
Practice Address - Phone:612-483-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN415464163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine