Provider Demographics
NPI:1083178123
Name:ANI, CHUMA
Entity Type:Individual
Prefix:
First Name:CHUMA
Middle Name:
Last Name:ANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHUMA
Other - Middle Name:
Other - Last Name:ANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12730 LEITRIM WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-2851
Mailing Address - Country:US
Mailing Address - Phone:832-868-0835
Mailing Address - Fax:832-303-4904
Practice Address - Street 1:12730 LEITRIM WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-2851
Practice Address - Country:US
Practice Address - Phone:832-868-0835
Practice Address - Fax:832-303-4904
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX777218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse