Provider Demographics
NPI:1215798137
Name:AGYARKO, NANA MANSAH (BSN, RN)
Entity type:Individual
Prefix:
First Name:NANA
Middle Name:MANSAH
Last Name:AGYARKO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GIORDANO AVE
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-4112
Mailing Address - Country:US
Mailing Address - Phone:973-277-8578
Mailing Address - Fax:
Practice Address - Street 1:901 ERNSTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2000
Practice Address - Country:US
Practice Address - Phone:732-585-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR23921800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty