Provider Demographics
NPI:1134680648
Name:TWENEBOAH-KODUAH, ELSIE ANTWIWAA (DNP,CRNP,PMHNP)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:ANTWIWAA
Last Name:TWENEBOAH-KODUAH
Suffix:
Gender:F
Credentials:DNP,CRNP,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 SPRY ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-5424
Mailing Address - Country:US
Mailing Address - Phone:317-797-9816
Mailing Address - Fax:
Practice Address - Street 1:317 SPRY ISLAND RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-5425
Practice Address - Country:US
Practice Address - Phone:667-434-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily