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General NPI Number Information
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NPI Number | 1841564739
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Entity Type | Individual
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Provider Name | CHARLES CHAKUNTEH NKAMJI CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 207 SCOTT ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-5518
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Country | US
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Telephone | 917-687-4307
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SCOTT ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-5518
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Country | US
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Telephone | 917-687-4307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN581266
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 534450-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 145116
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 082997
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR17106700
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NJ00493200
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License Number State | NJ
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