Provider Demographics
NPI:1528722451
Name:ADU, ALBERTA KOOSONO (CNP)
Entity type:Individual
Prefix:
First Name:ALBERTA
Middle Name:KOOSONO
Last Name:ADU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WYMAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1255
Mailing Address - Country:US
Mailing Address - Phone:774-354-8183
Mailing Address - Fax:617-915-8935
Practice Address - Street 1:303 WYMAN ST STE 300
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1255
Practice Address - Country:US
Practice Address - Phone:774-354-8183
Practice Address - Fax:617-915-8935
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2344956163W00000X
MARN2344956363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse