MEDICARE: LOUISA MENSAH OWUSU RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN187916	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN187916	OTHER	GA	RN

General Provider Information

NPI Number	:	1538787437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISA MENSAH OWUSU RN

Provider Business Mailing Address
First Line	:	2045 DOUBLE CREEK DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-7009
Country	:	US
Telephone Number	:	770-853-9558
Fax Number	:	678-388-0843

Provider Business Practice Location Address
First Line	:	2045 DOUBLE CREEK DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-7009
Country	:	US
Telephone Number	:	770-853-9558
Fax Number	:	678-388-0843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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