Provider Demographics
NPI:1649628702
Name:NYARKO, JOSEPHINE SELLY
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:SELLY
Last Name:NYARKO
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 1:8809 SUDLEY RD STE 213
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4749
Mailing Address - Country:US
Mailing Address - Phone:540-693-5310
Mailing Address - Fax:800-574-5153
Practice Address - Street 1:8809 SUDLEY RD STE 213
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4749
Practice Address - Country:US
Practice Address - Phone:540-693-5310
Practice Address - Fax:800-574-5153
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23728251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health