Provider Demographics
NPI:1033994876
Name:ADDO, ADUTWUMWAA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ADUTWUMWAA
Middle Name:
Last Name:ADDO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ADUTWUMWAA
Other - Middle Name:
Other - Last Name:BOADU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CHADWICK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1606
Mailing Address - Country:US
Mailing Address - Phone:973-706-2218
Mailing Address - Fax:
Practice Address - Street 1:12 CHADWICK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1606
Practice Address - Country:US
Practice Address - Phone:973-866-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN294404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty