Provider Demographics
NPI:1124753405
Name:ANYANWU, NNEKA (NP)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 TARES CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4362
Mailing Address - Country:US
Mailing Address - Phone:225-921-0851
Mailing Address - Fax:
Practice Address - Street 1:3033 CHIMNEY ROCK RD STE 519
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6260
Practice Address - Country:US
Practice Address - Phone:225-921-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020950363L00000X
TX1098553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95020950OtherFURNISHING NUMBER
TX1098553OtherTEXAS NP LICENSE