Provider Demographics
NPI:1841564739
Name:NKAMJI, CHARLES CHAKUNTEH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHAKUNTEH
Last Name:NKAMJI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5518
Mailing Address - Country:US
Mailing Address - Phone:917-687-4307
Mailing Address - Fax:
Practice Address - Street 1:207 SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5518
Practice Address - Country:US
Practice Address - Phone:917-687-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN581266163W00000X
NY534450-1163W00000X
TX145116163W00000X
PA082997367500000X
NJ26NR17106700163W00000X
NJ26NJ00493200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse