Healthcare Provider Details

I. General information

NPI: 1609301340
Provider Name (Legal Business Name): PHILIP ANTWI - BADU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49169 ROAD 426
OAKHURST CA
93644-8702
US

IV. Provider business mailing address

1960 LILY STEM TRL
AUBURN GA
30011-2150
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 770-855-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: