MEDICARE: NANCY AGYAPONG

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	164W00000X	Licensed Practical Nurse	337680	NY

General Provider Information

NPI Number	:	1811596000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY AGYAPONG

Provider Business Mailing Address
First Line	:	1735 LAFAYETTE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 LAFAYETTE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4171
Country	:	US
Telephone Number	:	917-859-9792
Fax Number	:

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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Directions to “ NANCY AGYAPONG ” Practice Location

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