Provider Demographics
NPI:1932975133
Name:ACHEAMPONG, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ACHEAMPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 E BETTERAVIA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7023
Mailing Address - Country:US
Mailing Address - Phone:704-906-4383
Mailing Address - Fax:
Practice Address - Street 1:1075 E BETTERAVIA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA MARIA
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:93454
Practice Address - Country:UM
Practice Address - Phone:704-906-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical