Provider Demographics
NPI:1114755808
Name:ANUGO, NDIDIAMAKA GLORY
Entity type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:GLORY
Last Name:ANUGO
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 1:23410 BAKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2567
Mailing Address - Country:US
Mailing Address - Phone:516-808-8081
Mailing Address - Fax:
Practice Address - Street 1:23410 BAKER HILL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2567
Practice Address - Country:US
Practice Address - Phone:516-808-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084851163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine