Healthcare Provider Details

I. General information

NPI: 1912764200
Provider Name (Legal Business Name): PATRICIA OWUSU-TWUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAUREL OAK RD
VOORHEES NJ
08043-4363
US

IV. Provider business mailing address

18 FOX HOLLOW LN
SICKLERVILLE NJ
08081-3933
US

V. Phone/Fax

Practice location:
  • Phone: 856-679-2185
  • Fax:
Mailing address:
  • Phone: 856-676-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number26NR14221900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: