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General NPI Number Information
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NPI Number | 1134733280
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Entity Type | Individual
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Provider Name | FREDA AGYEMANG NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/06/2020
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Last Update Date | 09/06/2020
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Provider Practice Location Address
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Address Line | 123 SUMMER ST
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City | WORCESTER
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State | MA
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Zip | 01608-1216
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Country | US
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Telephone | 508-363-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 55 RODNEY ST
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City | WORCESTER
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State | MA
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Zip | 01605-2859
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Country | US
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Telephone | 774-232-4654
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F08201034
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License Number State | MA
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