Provider Demographics
NPI:1922414747
Name:OFORI, BETINA BOAMAH (PNP, RN)
Entity Type:Individual
Prefix:
First Name:BETINA
Middle Name:BOAMAH
Last Name:OFORI
Suffix:
Gender:F
Credentials:PNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 TW ALEXANDER DR UNIT 1503
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7936
Mailing Address - Country:US
Mailing Address - Phone:703-589-6186
Mailing Address - Fax:
Practice Address - Street 1:834 W MEETING ST STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6220
Practice Address - Country:US
Practice Address - Phone:803-313-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001225591163W00000X
VA0024171805363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse