Provider Demographics
NPI:1487231122
Name:ACHEAMPONG, NASRAH SERWAH
Entity type:Individual
Prefix:
First Name:NASRAH
Middle Name:SERWAH
Last Name:ACHEAMPONG
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 1:500 RUSHING DR
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3748
Mailing Address - Country:US
Mailing Address - Phone:618-998-8808
Mailing Address - Fax:618-998-8809
Practice Address - Street 1:500 RUSHING DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3748
Practice Address - Country:US
Practice Address - Phone:618-998-8808
Practice Address - Fax:618-998-8809
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL36174962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program