Healthcare Provider Details

I. General information

NPI: 1609632769
Provider Name (Legal Business Name): DAVID KWADWO BOATENG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 207TH ST W
FARMINGTON MN
55024-8821
US

IV. Provider business mailing address

4413 207TH ST W
FARMINGTON MN
55024-8821
US

V. Phone/Fax

Practice location:
  • Phone: 612-483-9294
  • Fax:
Mailing address:
  • Phone: 612-483-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number415464
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: