Provider Demographics
NPI:1336617216
Name:ASARE, THEODORA
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:ASARE
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 1:3970 3RD AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8157
Mailing Address - Country:US
Mailing Address - Phone:347-845-2574
Mailing Address - Fax:
Practice Address - Street 1:3970 3RD AVE APT 509
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8157
Practice Address - Country:US
Practice Address - Phone:347-845-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329952164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse