Healthcare Provider Details

I. General information

NPI: 1083599484
Provider Name (Legal Business Name): BETTY KORANTEMAA OWUSU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 153RD ST APT 3H
JAMAICA NY
11432-3752
US

IV. Provider business mailing address

8825 153RD ST APT 3H
JAMAICA NY
11432-3752
US

V. Phone/Fax

Practice location:
  • Phone: 929-401-8355
  • Fax:
Mailing address:
  • Phone: 929-401-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number955188
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number955188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: