Provider Demographics
NPI:1780445940
Name:BUKONG-TAWE, WAWA ANITA (DNP)
Entity type:Individual
Prefix:DR
First Name:WAWA
Middle Name:ANITA
Last Name:BUKONG-TAWE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-2553
Mailing Address - Country:US
Mailing Address - Phone:908-656-2063
Mailing Address - Fax:
Practice Address - Street 1:26 MURPHY DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-2553
Practice Address - Country:US
Practice Address - Phone:908-656-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00948600363LF0000X, 363LP0200X
NJ26NR16941700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics