Provider Demographics
NPI:1891554960
Name:ACHU, IRENE NTAH (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:NTAH
Last Name:ACHU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:A
Other - Last Name:NTAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:11 SEASIDE TER # 2
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2028
Mailing Address - Country:US
Mailing Address - Phone:781-244-5180
Mailing Address - Fax:
Practice Address - Street 1:11 SEASIDE TER # SEASIDE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2028
Practice Address - Country:US
Practice Address - Phone:781-244-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349159163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty