MEDICARE: NANA DUA

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	363LF0000X	Family Nurse Practitioner	26NJ15240500	NJ

General Provider Information

NPI Number	:	1669284451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANA DUA

Provider Business Mailing Address
First Line	:	25 STATE ST
Second Line	:
City	:	CLARK
State	:	NJ
Zip	:	07066-3122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 NORWOOD AVE
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-1324
Country	:	US
Telephone Number	:	908-769-1400
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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Directions to “ NANA DUA ” Practice Location

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