Provider Demographics
NPI:1679043418
Name:DZAH, CHARLES EDEM YAWO (ARNP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDEM YAWO
Last Name:DZAH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31675 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5407
Mailing Address - Country:US
Mailing Address - Phone:253-215-1093
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:31675 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5407
Practice Address - Country:US
Practice Address - Phone:253-215-1093
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60911401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2157330Medicaid