Provider Demographics
NPI:1770926081
Name:OWUSU, JACOB (LPN)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:OWUSU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E 164TH ST
Mailing Address - Street 2:APT. 5D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6259
Mailing Address - Country:US
Mailing Address - Phone:917-392-5534
Mailing Address - Fax:
Practice Address - Street 1:224 E 164TH ST
Practice Address - Street 2:APT. 5D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6259
Practice Address - Country:US
Practice Address - Phone:917-392-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314005-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse