MEDICARE: NANA YAA SERWAA ADDAI DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	5013442	NC
2	363LG0600X	Gerontology Nurse Practitioner	5013442	NC
3	207Q00000X	Family Medicine Physician	5013442	NC
4	363LP2300X	Primary Care Nurse Practitioner	5013442	NC

General Provider Information

NPI Number	:	1114539814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANA YAA SERWAA ADDAI DNP

Provider Business Mailing Address
First Line	:	3901 CAPITAL BLVD STE 113
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-3487
Country	:	US
Telephone Number	:	984-282-9402
Fax Number	:	877-471-2993

Provider Business Practice Location Address
First Line	:	3901 CAPITAL BLVD STE 113
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-3487
Country	:	US
Telephone Number	:	984-282-9402
Fax Number	:	877-471-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	05/15/2026

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Practice Location Address:

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1033473293 — DR. TAWFIKUL ALAM M.D.
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1730974148 — TAMEKA SHIPMAN
Practice Location Address:

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Practice Fax:

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