Provider Demographics
NPI:1528686417
Name:ANYIM, AUGUSTINA OGECHI (RN)
Entity type:Individual
Prefix:MRS
First Name:AUGUSTINA
Middle Name:OGECHI
Last Name:ANYIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 SHORE BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4251
Mailing Address - Country:US
Mailing Address - Phone:682-240-7749
Mailing Address - Fax:
Practice Address - Street 1:6810 SHORE BREEZE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4251
Practice Address - Country:US
Practice Address - Phone:682-240-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX885786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse