Provider Demographics
NPI:1790677664
Name:KONADU AMPRATWUM, NANA YAA
Entity type:Individual
Prefix:
First Name:NANA YAA
Middle Name:
Last Name:KONADU AMPRATWUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANA
Other - Middle Name:
Other - Last Name:KONADU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1103 FOXTROT CT
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-9306
Mailing Address - Country:US
Mailing Address - Phone:434-227-6359
Mailing Address - Fax:
Practice Address - Street 1:849 WATERWORKS RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1956
Practice Address - Country:US
Practice Address - Phone:336-595-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily