Provider Demographics
NPI:1427768662
Name:FYNN BANSAH, BENE
Entity type:Individual
Prefix:
First Name:BENE
Middle Name:
Last Name:FYNN BANSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N ROLLING RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4142
Mailing Address - Country:US
Mailing Address - Phone:443-791-1456
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 303
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4142
Practice Address - Country:US
Practice Address - Phone:443-791-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse