Healthcare Provider Details

I. General information

NPI: 1407842370
Provider Name (Legal Business Name): NAA ADAAWAH WILSON-KUMI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST STE 1
WATERBURY CT
06706-1281
US

IV. Provider business mailing address

112 PLEASANT DR
SOUTHBURY CT
06488-3231
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-6185
  • Fax:
Mailing address:
  • Phone: 240-899-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-197396
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN966002
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number109131
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number005239
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberSRA25033
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: