Provider Demographics
NPI:1073165767
Name:ANYANWU, OBIAGERI IHUOMA (APN)
Entity Type:Individual
Prefix:
First Name:OBIAGERI
Middle Name:IHUOMA
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6403
Mailing Address - Country:US
Mailing Address - Phone:908-868-7437
Mailing Address - Fax:
Practice Address - Street 1:755 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6403
Practice Address - Country:US
Practice Address - Phone:908-868-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00929800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health