Provider Demographics
NPI:1336024363
Name:ACHU, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ACHU
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 1:4030 58TH AVE S UNIT F
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7940
Mailing Address - Country:US
Mailing Address - Phone:218-230-6459
Mailing Address - Fax:
Practice Address - Street 1:4030 58TH AVE S UNIT F
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7940
Practice Address - Country:US
Practice Address - Phone:218-230-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant