Healthcare Provider Details

I. General information

NPI: 1912464017
Provider Name (Legal Business Name): BETTY NYANTAKYIWAAH BOATENG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETTY NYANTAKYIWAAH AKWABOAH RN

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7313 FALLBROOK AVE
WEST HILLS CA
91307-2105
US

IV. Provider business mailing address

7313 FALLBROOK AVE
WEST HILLS CA
91307-2105
US

V. Phone/Fax

Practice location:
  • Phone: 323-788-2719
  • Fax:
Mailing address:
  • Phone: 323-788-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number704253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: