MEDICARE: IRENE OWUSU ANSAH HHA

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	374U00000X	Home Health Aide	26NH21915000	NJ

General Provider Information

NPI Number	:	1568211886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE OWUSU ANSAH HHA

Provider Business Mailing Address
First Line	:	1139 E JERSEY ST STE 203
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 E JERSEY ST STE 203
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2431
Country	:	US
Telephone Number	:	732-226-7643
Fax Number	:

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

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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