Provider Demographics
NPI:1801234315
Name:AWUKU, ANTHONY (LPN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:AWUKU
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 1:95 FORT HILL TER
Mailing Address - Street 2:APT. 10
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4228
Mailing Address - Country:US
Mailing Address - Phone:585-455-5232
Mailing Address - Fax:
Practice Address - Street 1:95 FORT HILL TER
Practice Address - Street 2:APT. 10
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4228
Practice Address - Country:US
Practice Address - Phone:585-455-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310441164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse