MEDICARE: FORSON ADDAE BOATENG RN-REGISTERED NURSE

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	163W00000X	Registered Nurse	RN00162766	WA

General Provider Information

NPI Number	:	1760112536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORSON ADDAE BOATENG RN-REGISTERED NURSE

Provider Business Mailing Address
First Line	:	5707 S AUGUSTA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98178-2814
Country	:	US
Telephone Number	:	206-898-1335
Fax Number	:	206-413-5197

Provider Business Practice Location Address
First Line	:	5707 S AUGUSTA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98178-2814
Country	:	US
Telephone Number	:	206-898-1335
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	11/18/2024

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