Individual
VIDA ADUSEI-POKU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3330 BOURBON ST STE 108, FREDERICKSBURG, VA 22408-7333
(703) 987-5052
Mailing address
3330 BOURBON ST STE 108, FREDERICKSBURG, VA 22408-7333
(703) 987-5052
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
HCO-151153
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821487950
—
VA
Enumeration date
10/15/2015
Last updated
10/15/2015
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