Provider Demographics
NPI:1790476802
Name:CHRYSSOS, ANNIKA STASA (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:ANNIKA
Middle Name:STASA
Last Name:CHRYSSOS
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 AVALANCHE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-6383
Mailing Address - Country:US
Mailing Address - Phone:775-450-6946
Mailing Address - Fax:
Practice Address - Street 1:140 AVALANCHE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-6383
Practice Address - Country:US
Practice Address - Phone:775-450-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program