Provider Demographics
NPI:1316755002
Name:BOAKYE, YAA (RDN)
Entity type:Individual
Prefix:MISS
First Name:YAA
Middle Name:
Last Name:BOAKYE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6076
Mailing Address - Country:US
Mailing Address - Phone:872-203-1871
Mailing Address - Fax:
Practice Address - Street 1:165 S WESTON AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6076
Practice Address - Country:US
Practice Address - Phone:872-203-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13095133V00000X
NV40885-DI-0133V00000X
TXDT89929133V00000X
GALD006932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered