Healthcare Provider Details

I. General information

NPI: 1548197742
Provider Name (Legal Business Name): GYAMERA YEBOAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HAWKEN ST APT 107
BISMARCK ND
58503-1362
US

IV. Provider business mailing address

2700 HAWKEN ST APT 107
BISMARCK ND
58503-1362
US

V. Phone/Fax

Practice location:
  • Phone: 701-609-8600
  • Fax:
Mailing address:
  • Phone: 701-609-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberTAXC2025-002
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: