Healthcare Provider Details

I. General information

NPI: 1063865806
Provider Name (Legal Business Name): GRACE OPOKU-MENSAH RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE OPOKU-MENSAH FNP-C

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 09/05/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ELGAR PL APT 5J
BRONX NY
10475-5242
US

IV. Provider business mailing address

140 ELGAR PL APT 5J
BRONX NY
10475-5242
US

V. Phone/Fax

Practice location:
  • Phone: 917-214-4284
  • Fax:
Mailing address:
  • Phone: 917-214-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08240538
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number710366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: