Provider Demographics
NPI:1720697683
Name:ANEBERE, IMMACULATE OBIAGELI (NP)
Entity type:Individual
Prefix:
First Name:IMMACULATE
Middle Name:OBIAGELI
Last Name:ANEBERE
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 1:17661 LOGANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7456
Mailing Address - Country:US
Mailing Address - Phone:310-256-6448
Mailing Address - Fax:
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:323-290-2832
Practice Address - Fax:323-290-2836
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014842363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner