Healthcare Provider Details

I. General information

NPI: 1104166420
Provider Name (Legal Business Name): ADWOAH PINAMANG BONSU ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD STE 201
SUMMIT NJ
07901-3562
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5040
  • Fax: 908-522-5041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306076
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number605444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: