Healthcare Provider Details

I. General information

NPI: 1982910618
Provider Name (Legal Business Name): ADAORAH AZOTAM MSN, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADAORAH AZOTAM PHD, RN, CPNP-PC

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2331
  • Fax: 214-456-2897
Mailing address:
  • Phone: 214-456-2331
  • Fax: 214-456-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP010859
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP130706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: