Provider Demographics
NPI:1881951747
Name:OWUSU, EDWARD KWAKU (LPN)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KWAKU
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 1:23 E 3RD ST
Mailing Address - Street 2:APT. B 21
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3953
Mailing Address - Country:US
Mailing Address - Phone:914-309-4250
Mailing Address - Fax:
Practice Address - Street 1:23 E 3RD ST
Practice Address - Street 2:APT. B 21
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3953
Practice Address - Country:US
Practice Address - Phone:914-309-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308986-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse