Provider Demographics
NPI:1891785762
Name:ANKIAMBOM, CHRISTIANA J (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:J
Last Name:ANKIAMBOM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:JULIANA
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:PO BOX 417297
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7297
Mailing Address - Country:US
Mailing Address - Phone:866-623-3869
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5141
Practice Address - Country:US
Practice Address - Phone:860-585-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122652163W00000X
NY362351163W00000X
OH314823163W00000X
CT005978367500000X
OH07924367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
53698OtherAANA
OH2539604Medicaid
OHAN8234415Medicare PIN