Provider Demographics
NPI:1982910618
Name:AZOTAM, ADAORAH (MSN, RN, CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:ADAORAH
Middle Name:
Last Name:AZOTAM
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:DR
Other - First Name:ADAORAH
Other - Middle Name:
Other - Last Name:AZOTAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, RN, CPNP-PC
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-2331
Mailing Address - Fax:214-456-2897
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-2331
Practice Address - Fax:214-456-2897
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010859363LP0200X
TXAP130706363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics