1265716211 NPI number — MARY AGYEMANG ADINKRAH RN

Table of content: MARCELLIS MINOR JR. (NPI 1740085752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265716211 NPI number — MARY AGYEMANG ADINKRAH RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADINKRAH
Provider First Name:
MARY
Provider Middle Name:
AGYEMANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGYEMANG
Provider Other First Name:
MARY
Provider Other Middle Name:
BIRAGO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265716211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 S MERRILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01835-7743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-241-5698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01901-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-581-3900
Provider Business Practice Location Address Fax Number:
781-598-9345
Provider Enumeration Date:
10/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  RN2264041 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)