Provider Demographics
NPI:1174751598
Name:TUAKLI-WOSORNU, YETSA ADEBODUNDE (MD, MPH)
Entity type:Individual
Prefix:
First Name:YETSA
Middle Name:ADEBODUNDE
Last Name:TUAKLI-WOSORNU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858 MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:717-531-5814
Mailing Address - Fax:717-531-0494
Practice Address - Street 1:1135 OLDE W CHOCOLATE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9188
Practice Address - Country:US
Practice Address - Phone:717-531-7010
Practice Address - Fax:717-531-7102
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29657208100000X
MA261307208100000X
CT56359208100000X
PAMD473321208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008057688Medicaid