Provider Demographics
NPI:1487333829
Name:KANNEH, BOAKAI MUSA
Entity type:Individual
Prefix:MR
First Name:BOAKAI
Middle Name:MUSA
Last Name:KANNEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12153 72ND ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5064
Mailing Address - Country:US
Mailing Address - Phone:612-709-3880
Mailing Address - Fax:612-454-2583
Practice Address - Street 1:12153 72ND ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-5064
Practice Address - Country:US
Practice Address - Phone:612-709-3880
Practice Address - Fax:612-454-2583
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker