Provider Demographics
NPI:1609640119
Name:NUM-BOATEMAA, GRACE N/A (NP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:N/A
Last Name:NUM-BOATEMAA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:N/A
Other - Last Name:NUM-BOATEMAA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1545 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1303
Mailing Address - Country:US
Mailing Address - Phone:302-832-8701
Mailing Address - Fax:
Practice Address - Street 1:1545 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1303
Practice Address - Country:US
Practice Address - Phone:302-544-1395
Practice Address - Fax:302-544-1395
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily