MEDICARE: MRS. AKOSUA OWUSUAH BOAKYE-YIADOM NP-C

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	363LF0000X	Family Nurse Practitioner	5016688	NC

General Provider Information

NPI Number	:	1699493858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AKOSUA OWUSUAH BOAKYE-YIADOM NP-C

Provider Business Mailing Address
First Line	:	2111 COPPER TOP CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-1966
Country	:	US
Telephone Number	:	973-666-9902
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4058
Country	:	US
Telephone Number	:	704-409-3000
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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