Provider Demographics
NPI:1194224881
Name:ANYATONWU, NGOZI INA-KALU (NP)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:INA-KALU
Last Name:ANYATONWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NGOZI
Other - Middle Name:INA-KALU
Other - Last Name:ANYATONWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:7603 SUMMER SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4662
Mailing Address - Country:US
Mailing Address - Phone:713-518-8898
Mailing Address - Fax:
Practice Address - Street 1:7603 SUMMER SHORE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-4662
Practice Address - Country:US
Practice Address - Phone:713-518-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747390OtherRN LICENSE
TXAP135923OtherAPRN LICENSE