Provider Demographics
NPI:1205558855
Name:BOATENG, KWABENA A (BS,MS)
Entity type:Individual
Prefix:
First Name:KWABENA
Middle Name:A
Last Name:BOATENG
Suffix:
Gender:M
Credentials:BS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 MIRANDA CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5145
Mailing Address - Country:US
Mailing Address - Phone:804-898-5981
Mailing Address - Fax:
Practice Address - Street 1:2569 MIRANDA CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5145
Practice Address - Country:US
Practice Address - Phone:804-898-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health