Provider Demographics
NPI:1588430979
Name:ANUNOBI, INNOCENT CHIDERA (APRN)
Entity type:Individual
Prefix:
First Name:INNOCENT
Middle Name:CHIDERA
Last Name:ANUNOBI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2488
Mailing Address - Country:US
Mailing Address - Phone:214-218-5704
Mailing Address - Fax:
Practice Address - Street 1:7300 ELDORADO PKWY STE 225
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3590
Practice Address - Country:US
Practice Address - Phone:972-893-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142455363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health