Provider Demographics
NPI:1881369205
Name:BOATENG, CATHERINE A
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:BOATENG
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 1:9610 57TH AVE APT 9F
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3412
Mailing Address - Country:US
Mailing Address - Phone:347-690-9132
Mailing Address - Fax:
Practice Address - Street 1:9610 57TH AVE APT 9F
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3412
Practice Address - Country:US
Practice Address - Phone:347-690-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program