Provider Demographics
NPI:1447067251
Name:BOATENG, PORTIA
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:BOATENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7624 MANGIONE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7603
Mailing Address - Country:US
Mailing Address - Phone:571-276-1376
Mailing Address - Fax:
Practice Address - Street 1:7624 MANGIONE CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7603
Practice Address - Country:US
Practice Address - Phone:571-276-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1784343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)