Healthcare Provider Details

I. General information

NPI: 1083503726
Provider Name (Legal Business Name): FANTA KROMAH ZOKAI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5902 OLD YORK RD
PHILADELPHIA PA
19141-2342
US

IV. Provider business mailing address

1534 LLANWELLYN AVE
FOLCROFT PA
19032-1024
US

V. Phone/Fax

Practice location:
  • Phone: 215-930-4500
  • Fax: 215-930-4500
Mailing address:
  • Phone: 215-498-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN319070
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: