Provider Demographics
NPI:1770962425
Name:ADUBOFOUR, MERCY
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:ADUBOFOUR
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 1:22 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4527
Mailing Address - Country:US
Mailing Address - Phone:571-398-7163
Mailing Address - Fax:
Practice Address - Street 1:22 OXFORD CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4527
Practice Address - Country:US
Practice Address - Phone:571-398-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY699678163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse