Provider Demographics
NPI:1790476968
Name:ASIAMAH, LOUISA OBENEWA
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:OBENEWA
Last Name:ASIAMAH
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 1:100 GROVE ST STE 115
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2630
Mailing Address - Country:US
Mailing Address - Phone:214-597-0265
Mailing Address - Fax:
Practice Address - Street 1:100 GROVE ST STE 115
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2630
Practice Address - Country:US
Practice Address - Phone:214-597-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280635163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse