Provider Demographics
NPI:1093364622
Name:ARCHIBONG, CHRISTIANA
Entity type:Individual
Prefix:MRS
First Name:CHRISTIANA
Middle Name:
Last Name:ARCHIBONG
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 1:21508 W 51ST PL
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-9731
Mailing Address - Country:US
Mailing Address - Phone:913-486-2906
Mailing Address - Fax:
Practice Address - Street 1:21508 W 51ST PL
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-9731
Practice Address - Country:US
Practice Address - Phone:913-486-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78718-041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily