Healthcare Provider Details

I. General information

NPI: 1497480305
Provider Name (Legal Business Name): HAGAR KYEIWAA BAAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 07/24/2022
Certification Date: 07/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 FARRAR AVE
WORCESTER MA
01604-3260
US

IV. Provider business mailing address

95 FARRAR AVE
WORCESTER MA
01604-3260
US

V. Phone/Fax

Practice location:
  • Phone: 774-386-8160
  • Fax:
Mailing address:
  • Phone: 774-386-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2316358
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: