Provider Demographics
NPI:1508646290
Name:ADDO, JOHN (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ADDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 VIRGINIA ST APT C
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3012
Mailing Address - Country:US
Mailing Address - Phone:908-977-7153
Mailing Address - Fax:
Practice Address - Street 1:1279 VIRGINIA ST APT C
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3012
Practice Address - Country:US
Practice Address - Phone:908-977-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY891376-01163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health