Healthcare Provider Details

I. General information

NPI: 1881349140
Provider Name (Legal Business Name): ALFRED OWUSU-ANSAH DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DEER RUN
CHARLTON MA
01507-1577
US

IV. Provider business mailing address

19 DEER RUN
CHARLTON MA
01507-1577
US

V. Phone/Fax

Practice location:
  • Phone: 508-612-4881
  • Fax:
Mailing address:
  • Phone: 508-612-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG02220081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: