Provider Demographics
NPI:1386088029
Name:NDUOM, NANA ABA (MD)
Entity type:Individual
Prefix:
First Name:NANA
Middle Name:ABA
Last Name:NDUOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABA
Other - Middle Name:
Other - Last Name:NDUOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16771 NE 80TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3959
Mailing Address - Country:US
Mailing Address - Phone:425-414-8799
Mailing Address - Fax:425-217-2427
Practice Address - Street 1:16771 NE 80TH ST STE 108
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3959
Practice Address - Country:US
Practice Address - Phone:425-414-8799
Practice Address - Fax:425-217-2427
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML603771242084P0800X, 2084P0804X
WAMD605842562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA503763Medicare UPIN