Healthcare Provider Details

I. General information

NPI: 1679043418
Provider Name (Legal Business Name): CHARLES EDEM YAWO DZAH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31675 PACIFIC HWY S
FEDERAL WAY WA
98003-5407
US

IV. Provider business mailing address

31675 PACIFIC HWY S
FEDERAL WAY WA
98003-5407
US

V. Phone/Fax

Practice location:
  • Phone: 253-215-1093
  • Fax: 253-426-6344
Mailing address:
  • Phone: 253-215-1093
  • Fax: 253-426-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60911401
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: