Provider Demographics
NPI:1255099750
Name:BOAMPONG, COMFORT ANIMAH (NP)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:ANIMAH
Last Name:BOAMPONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 MASSASOIT RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3568
Mailing Address - Country:US
Mailing Address - Phone:508-335-7015
Mailing Address - Fax:
Practice Address - Street 1:425, NORTH LAKE AVE
Practice Address - Street 2:WORCESTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-753-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA07211109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily