1376856112 NPI number — MRS. EWURAMA AFADZIWA AMPOFO APRN,NP-C

Table of content: MRS. EWURAMA AFADZIWA AMPOFO APRN,NP-C (NPI 1376856112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376856112 NPI number — MRS. EWURAMA AFADZIWA AMPOFO APRN,NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMPOFO
Provider First Name:
EWURAMA
Provider Middle Name:
AFADZIWA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN,NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAYFORD
Provider Other First Name:
EWURAMA
Provider Other Middle Name:
AFADZIWA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, NP-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376856112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 BLUE RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06066-5839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-712-5956
Provider Business Mailing Address Fax Number:
860-969-0829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-712-5956
Provider Business Practice Location Address Fax Number:
860-969-0829
Provider Enumeration Date:
07/22/2010

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: 363LP2300X , with the licence number:  004400 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 12.004400 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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