Provider Demographics
NPI:1588345045
Name:AGYEKUM, ADJOA BIAMAH
Entity type:Individual
Prefix:
First Name:ADJOA
Middle Name:BIAMAH
Last Name:AGYEKUM
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 1:7515 WILLIAMSON RD # 6292
Mailing Address - Street 2:
Mailing Address - City:HOLLINS
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4301
Mailing Address - Country:US
Mailing Address - Phone:540-563-1010
Mailing Address - Fax:
Practice Address - Street 1:7515 WILLIAMSON RD # 6292
Practice Address - Street 2:
Practice Address - City:HOLLINS
Practice Address - State:VA
Practice Address - Zip Code:24019-4301
Practice Address - Country:US
Practice Address - Phone:540-563-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily