Provider Demographics
NPI:1407842370
Name:WILSON-KUMI, NAA ADAAWAH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:NAA
Middle Name:ADAAWAH
Last Name:WILSON-KUMI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3231
Mailing Address - Country:US
Mailing Address - Phone:240-899-1993
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:SUITE 333
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3315
Practice Address - Country:US
Practice Address - Phone:860-972-2117
Practice Address - Fax:860-545-1784
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-197396367500000X
COSRA25033367500000X
DCRN966002367500000X
CT109131367500000X
CT005239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404579300Medicaid
COP00956867OtherMEDICARE RR
MDP00745078OtherMEDICARE RAILROAD
CO82681279Medicaid
MDKBC1CHOtherCAREFIRST BCBS
DCS417-0022OtherCAREFIRST BCBS
MDP00745078OtherMEDICARE RAILROAD
COCOA102637Medicare PIN