Healthcare Provider Details

I. General information

NPI: 1114539814
Provider Name (Legal Business Name): NANA YAA SERWAA ADDAI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL BLVD STE 113
RALEIGH NC
27604-3487
US

IV. Provider business mailing address

3901 CAPITAL BLVD STE 113
RALEIGH NC
27604-3487
US

V. Phone/Fax

Practice location:
  • Phone: 984-282-9402
  • Fax: 877-471-2993
Mailing address:
  • Phone: 984-282-9402
  • Fax: 877-471-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5013442
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5013442
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5013442
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5013442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: