Doctor Name: | MR. YAW BOATENG |
NPI Number: | 1053752683 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.D., C.D.E. |
License Number: | 382 |
Business Practice Address: | 635 W Wesmark Blvd Sumter, SC - 291501900 |
Business Phone Number: | 8034697500 |
Business Fax Number: | 8034697533 |
Mailing Address: | 2315 Stadium Rd, SUMTER |
State: | SC |
Postal Code: | 291546158 |
Phone Number: | 8034817983 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2013 |
NPI Last Update Date: | 07/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133NN1002X |
License Number: | 382 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Nutritionist |
Taxonomy Specialization: | Nutrition, Education |
Taxonomy Definition: |