Provider Demographics
NPI:1396167086
Name:OPOKU, STEPHEN KWASI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KWASI
Last Name:OPOKU
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:OPOKU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:75 PERRY LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-7000
Mailing Address - Country:US
Mailing Address - Phone:203-260-4146
Mailing Address - Fax:203-503-3254
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3250
Practice Address - Fax:203-503-3254
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005620363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health