Provider Demographics
NPI:1093254492
Name:ANYANWU, CHINYERE NGOZI
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:NGOZI
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10218 LEWIS LN
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-5535
Mailing Address - Country:US
Mailing Address - Phone:904-881-5438
Mailing Address - Fax:
Practice Address - Street 1:21315 BELLA LUNA CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5660
Practice Address - Country:US
Practice Address - Phone:904-881-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily