Basic Information
| Provider Information | |||||||||
| NPI: | 1407842370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON-KUMI | ||||||||
| FirstName: | NAA | ||||||||
| MiddleName: | ADAAWAH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 PLEASANT DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064883231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408991993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 SEYMOUR ST | ||||||||
| Address2: | SUITE 333 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609722117 | ||||||||
| FaxNumber: | 8605451784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 01/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN-197396 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | SRA25033 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN966002 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 109131 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 005239 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 404579300 | 05 | MD | MEDICAID | P00956867 | 01 | CO | MEDICARE RR | OTHER | P00745078 | 01 | MD | MEDICARE RAILROAD | OTHER | 82681279 | 05 | CO | MEDICAID | KBC1CH | 01 | MD | CAREFIRST BCBS | OTHER | S417-0022 | 01 | DC | CAREFIRST BCBS | OTHER |