Healthcare Provider Details

I. General information

NPI: 1124268271
Provider Name (Legal Business Name): CHRISTOS ADDAI-ACHAMPONG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 98 & NAVAJO RT 16 INSCRIPTION HOUSE HEALTH CENTER
TONALEA AZ
86044
US

IV. Provider business mailing address

PO BOX 368
KAYENTA AZ
86033-0368
US

V. Phone/Fax

Practice location:
  • Phone: 928-672-3000
  • Fax:
Mailing address:
  • Phone: 928-672-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN072717
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: