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General NPI Number Information
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NPI Number | 1053094326
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Entity Type | Individual
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Provider Name | DAMIAN CHUKWUNYERENDU AMANFO
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Gender | Male
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 226 FIELD ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-2133
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Country | US
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Telephone | 508-979-5557
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Fax | 508-979-5955
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Provider Business Mailing Address
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Address Line | 106 LUNDBERG ST
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City | LOWELL
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State | MA
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Zip | 01852-5375
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Country | US
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Telephone | 978-328-6138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2262235
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License Number State | MA
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