Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 61107-20 | WI |
N | 208600000X | Surgeon | 61107-20 | WI |
Y | 208200000X | Surgeon | MD.201432 | LA |
Y | 208600000X | Surgeon | MD.201432 | LA |
N | 2086X0206X | Surgical Oncologist | 61107 | WI |
NPI | 1194915405 |
---|---|
Provider Name | Adwoa Serwah Opoku-Boateng |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194915405 | (05) | WI |