Provider Demographics
NPI:1730625047
Name:ACCOUNTIUS, DOUGLAS (RN, MBA, AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ACCOUNTIUS
Suffix:
Gender:M
Credentials:RN, MBA, AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5685
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-5685
Mailing Address - Country:US
Mailing Address - Phone:505-635-6547
Mailing Address - Fax:505-365-6547
Practice Address - Street 1:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - Street 2:HIGHWAY 491 NORTH
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-5685
Practice Address - Country:US
Practice Address - Phone:505-368-6462
Practice Address - Fax:505-365-6547
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03124363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care