Healthcare Provider Details

I. General information

NPI: 1891785762
Provider Name (Legal Business Name): CHRISTIANA J ANKIAMBOM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIANA JULIANA CARTER RN, CRNA

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD
BRISTOL CT
06010-5141
US

IV. Provider business mailing address

PO BOX 417297
BOSTON MA
02241-7297
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3474
  • Fax:
Mailing address:
  • Phone: 866-623-3869
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122652
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number362351
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number314823
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number005978
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number07924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: