Provider Demographics
NPI:1265711345
Name:OSAE, KENNEDY WIAFE (LPN)
Entity type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:WIAFE
Last Name:OSAE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WARBURTON AVE
Mailing Address - Street 2:APT. 11M
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2544
Mailing Address - Country:US
Mailing Address - Phone:917-915-1140
Mailing Address - Fax:
Practice Address - Street 1:160 WARBURTON AVE
Practice Address - Street 2:APT. 11M
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2544
Practice Address - Country:US
Practice Address - Phone:917-915-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305612-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse