Provider Demographics
NPI:1831483999
Name:YEBOAH, GIFTY (LPN)
Entity Type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MCCLELLAN ST
Mailing Address - Street 2:APT-5E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8641
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:80 MCCLELLAN ST
Practice Address - Street 2:APT-5E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8641
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse