Healthcare Provider Details

I. General information

NPI: 1124317482
Provider Name (Legal Business Name): NANA YAA ADDO-BOAFO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W CAMDEN ST
BALTIMORE MD
21201-7912
US

IV. Provider business mailing address

853 OAK FOREST DR
MORROW OH
45152-7914
US

V. Phone/Fax

Practice location:
  • Phone: 513-328-0772
  • Fax:
Mailing address:
  • Phone: 513-328-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 17154-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 336178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: