Healthcare Provider Details

I. General information

NPI: 1558537993
Provider Name (Legal Business Name): CYNTHIA OWUSU-ANSAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 DAKOTA AVE
WOODBURY MN
55125-5003
US

IV. Provider business mailing address

3520 DAKOTA AVE
WOODBURY MN
55125-5003
US

V. Phone/Fax

Practice location:
  • Phone: 651-501-7983
  • Fax:
Mailing address:
  • Phone: 651-501-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-166284-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: