Provider Demographics
NPI:1912784315
Name:NYARKO, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NYARKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2740
Mailing Address - Country:US
Mailing Address - Phone:401-454-1743
Mailing Address - Fax:401-454-1728
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2740
Practice Address - Country:US
Practice Address - Phone:401-454-1743
Practice Address - Fax:401-454-1728
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN4332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty