Provider Demographics
NPI:1063166601
Name:ANIEKWENA, ERIC C
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:ANIEKWENA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 N DIVISION ST # 1024
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2129
Mailing Address - Country:US
Mailing Address - Phone:509-209-8854
Mailing Address - Fax:509-209-8857
Practice Address - Street 1:8026 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-990-1143
Practice Address - Fax:509-209-8857
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61524815363LP0808X
TX1070199363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health