Healthcare Provider Details

I. General information

NPI: 1487404034
Provider Name (Legal Business Name): NANA KWADWO MANUKURE OPOKU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MEDICAL CENTER DR
FISHERSVILLE VA
22939-2332
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-7987
  • Fax:
Mailing address:
  • Phone: 540-332-5168
  • Fax: 540-332-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116039431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: