Provider Demographics
NPI:1760946834
Name:AGYEMANG-BOATENG, LETICIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:AGYEMANG-BOATENG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:OSEI-MENSAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 OAKRANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512
Mailing Address - Country:US
Mailing Address - Phone:973-752-5334
Mailing Address - Fax:732-508-6041
Practice Address - Street 1:31 OAKRANCH ROAD
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512
Practice Address - Country:US
Practice Address - Phone:973-752-5334
Practice Address - Fax:732-508-6041
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18677900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse