Provider Demographics
NPI:1376969204
Name:ETCHI, NKENGAFAC (CNP, FNP)
Entity Type:Individual
Prefix:
First Name:NKENGAFAC
Middle Name:
Last Name:ETCHI
Suffix:
Gender:F
Credentials:CNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MARJORAM DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-7027
Mailing Address - Country:US
Mailing Address - Phone:614-584-4270
Mailing Address - Fax:
Practice Address - Street 1:1251 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1359
Practice Address - Country:US
Practice Address - Phone:614-584-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024052363L00000X
OH393025163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1376969204OtherCENTERS FOR MEDICARE AND MEDICAID SERVICES