Provider Demographics
NPI:1477217180
Name:WARD, ADUNNI MUDIWA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ADUNNI
Middle Name:MUDIWA
Last Name:WARD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N WYCOMBE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1618
Mailing Address - Country:US
Mailing Address - Phone:973-220-5984
Mailing Address - Fax:
Practice Address - Street 1:240 N WYCOMBE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1618
Practice Address - Country:US
Practice Address - Phone:973-220-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024388363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA710723719777Medicaid