Provider Demographics
NPI:1861167082
Name:AMOFA, AMA ASUBONTENG (FNP-C)
Entity type:Individual
Prefix:
First Name:AMA
Middle Name:ASUBONTENG
Last Name:AMOFA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7299 BELFONTE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9196
Mailing Address - Country:US
Mailing Address - Phone:573-645-7695
Mailing Address - Fax:
Practice Address - Street 1:1400 E CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5316
Practice Address - Country:US
Practice Address - Phone:812-239-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224828A163W00000X, 163W00000X
IN71011554A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily