Healthcare Provider Details

I. General information

NPI: 1013677087
Provider Name (Legal Business Name): PHILOMINA GYEDU ANKOMAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 LEEDS ST
LOWELL MA
01850-1159
US

IV. Provider business mailing address

76 LEEDS ST
LOWELL MA
01850-1159
US

V. Phone/Fax

Practice location:
  • Phone: 978-328-2901
  • Fax:
Mailing address:
  • Phone: 978-328-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2331681
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: