Provider Demographics
NPI:1700269602
Name:BEYEEMANG, HENRIETTA
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:
Last Name:BEYEEMANG
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 1:230 ECHO PL
Mailing Address - Street 2:APT 2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5693
Mailing Address - Country:US
Mailing Address - Phone:646-881-3568
Mailing Address - Fax:
Practice Address - Street 1:230 ECHO PL
Practice Address - Street 2:APT 2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5693
Practice Address - Country:US
Practice Address - Phone:646-881-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse