Healthcare Provider Details

I. General information

NPI: 1104155464
Provider Name (Legal Business Name): MR. ANTHONY KWABENA NKYI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W NORFOLK AVE
NORFOLK NE
68701-5006
US

IV. Provider business mailing address

900 W NORFOLK AVE
NORFOLK NE
68701-5006
US

V. Phone/Fax

Practice location:
  • Phone: 402-370-3140
  • Fax: 402-370-3373
Mailing address:
  • Phone: 402-370-3140
  • Fax: 402-370-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8793
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: