Provider Demographics
NPI:1144528209
Name:ANTWI, SAMUEL (FNP-BC, PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:ANTWI
Suffix:
Gender:M
Credentials:FNP-BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 18TH ST NW STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2505
Mailing Address - Country:US
Mailing Address - Phone:202-223-0969
Mailing Address - Fax:202-223-0963
Practice Address - Street 1:1601 18TH ST NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2505
Practice Address - Country:US
Practice Address - Phone:202-223-0969
Practice Address - Fax:202-223-0963
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1027557363LF0000X, 363LF0000X
NH065388-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD068468600Medicaid
VA2013242030Medicaid
DC047277600Medicaid
DC047277600Medicaid