Provider Demographics
NPI:1861738551
Name:AWOTWE, MARTHA AKUA
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:AKUA
Last Name:AWOTWE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:AKUA
Other - Last Name:AWOTWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:24111 148TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3282
Mailing Address - Country:US
Mailing Address - Phone:718-949-1780
Mailing Address - Fax:
Practice Address - Street 1:24111 148TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3282
Practice Address - Country:US
Practice Address - Phone:718-949-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567731 1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY587731 1OtherRN