Provider Demographics
NPI:1942624069
Name:OWUSU-AGYEMANG, PRISCILLA
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:OWUSU-AGYEMANG
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 1:1085 GERARD AVENUE
Mailing Address - Street 2:APT.1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:347-998-2965
Mailing Address - Fax:
Practice Address - Street 1:1085 GERARD AVE
Practice Address - Street 2:APT.1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8870
Practice Address - Country:US
Practice Address - Phone:347-998-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317413-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse