Provider Demographics
NPI:1407108228
Name:EKWAM-MENSAH, AGATHA
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:EKWAM-MENSAH
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 1:522 W RIVERSIDE AVE STE N
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0581
Mailing Address - Country:US
Mailing Address - Phone:425-877-9191
Mailing Address - Fax:
Practice Address - Street 1:204 MT PARK BLVD SW APT C201
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3696
Practice Address - Country:US
Practice Address - Phone:425-877-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WARN00159127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse