Provider Demographics
NPI:1952826927
Name:OKOFO-MENSAH, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:OKOFO-MENSAH
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 1:1429 PROSPECT AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1265
Mailing Address - Country:US
Mailing Address - Phone:631-520-1047
Mailing Address - Fax:
Practice Address - Street 1:1429 PROSPECT AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1265
Practice Address - Country:US
Practice Address - Phone:631-520-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329090164W00000X
NY790939163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse