Healthcare Provider Details

I. General information

NPI: 1396329512
Provider Name (Legal Business Name): AMA MAAME ANTWIA NKANSAH-ANDOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SELINA ANTWIA OFORI-ATTA RN

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

PO BOX 130766
ANN ARBOR MI
48113-0766
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5768
  • Fax:
Mailing address:
  • Phone: 734-330-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704227337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: