Provider Demographics
NPI:1750113148
Name:ETIENDEM, ANDREW ACHANKENG
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ACHANKENG
Last Name:ETIENDEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 STONECASTLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6564
Mailing Address - Country:US
Mailing Address - Phone:614-596-9099
Mailing Address - Fax:
Practice Address - Street 1:4787 STONECASTLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6564
Practice Address - Country:US
Practice Address - Phone:614-596-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist