Healthcare Provider Details

I. General information

NPI: 1306932827
Provider Name (Legal Business Name): KORDOR YEBOAH C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 PENN STREET
READING PA
19602
US

IV. Provider business mailing address

838 PENN STREET
READING PA
19602
US

V. Phone/Fax

Practice location:
  • Phone: 610-988-4838
  • Fax: 610-288-4515
Mailing address:
  • Phone: 610-988-4838
  • Fax: 610-288-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP005319B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: