Healthcare Provider Details

I. General information

NPI: 1265205124
Provider Name (Legal Business Name): LEONA YVETTA OWUSU DAPAAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 STANTON RD
MOUNT HOLLY NJ
08060-1398
US

IV. Provider business mailing address

19 STANTON RD
MOUNT HOLLY NJ
08060-1398
US

V. Phone/Fax

Practice location:
  • Phone: 848-466-7571
  • Fax:
Mailing address:
  • Phone: 848-466-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14851300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: