MEDICARE: MISS MILLICENT AKOSUA BOAHEMAA F.N.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F335757-1	NY

General Provider Information

NPI Number	:	1164718359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MILLICENT AKOSUA BOAHEMAA F.N.P

Provider Business Mailing Address
First Line	:	460 W 34TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2382
Country	:	US
Telephone Number	:	212-926-3498
Fax Number	:

Provider Business Practice Location Address
First Line	:	2544 8TH AVE APT 4B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2454
Country	:	US
Telephone Number	:	212-926-3498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2011
Last Update Date	:	02/16/2016

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