Healthcare Provider Details

I. General information

NPI: 1730659731
Provider Name (Legal Business Name): EVELYN YEBOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 MORRIS AVE APT 3B
BRONX NY
10453-2053
US

IV. Provider business mailing address

2244 MORRIS AVE APT 3B
BRONX NY
10453-2053
US

V. Phone/Fax

Practice location:
  • Phone: 929-263-5824
  • Fax:
Mailing address:
  • Phone: 929-263-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number832706
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number332267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: