Provider Demographics
NPI:1144799305
Name:ANULIEKETTE, CHIDINMA (AGACNP)
Entity Type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:
Last Name:ANULIEKETTE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 WINDING DOWN WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1599
Mailing Address - Country:US
Mailing Address - Phone:404-200-3670
Mailing Address - Fax:
Practice Address - Street 1:1098 WINDING DOWN WAY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1599
Practice Address - Country:US
Practice Address - Phone:404-200-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136584363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty