Healthcare Provider Details

I. General information

NPI: 1548089063
Provider Name (Legal Business Name): AKUA SERWAAH OSEI POKU DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD STE 255
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

PO BOX 9000
PUEBLO CO
81008-9000
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-2235
  • Fax: 833-916-2049
Mailing address:
  • Phone: 719-553-1804
  • Fax: 719-553-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000210
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: